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HYGIENIC MEASURES 


IN RELATION TO 
INFECTIOUS DISEASES 


NUTTALL 


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ee MEASURES | 


IN > 


RELATION TO NFE ECTIOUS a 


COMPRISING IN CONDENSED FORM 


INFORMATION AS TO THE CAUSE AND MODE OF SPREADING 
OF CERTAIN DISEASES, THE PREVENTIVE MEASURES 
THAT SHOULD BE RESORTED TO, ISOLA- 

TION, DISINFECTION, ETC. 


BY 


GEORGE H. F. NUTTALL, M.D., Pu.D. (GOTTINGEN) 


ASSOCIATE IN HYGIENE AND BACTERIOLOGY, JOHNS HOPKINS UNIVERSITY AND 
HOSPITAL; MEMBER OF THE ASSOCIATION OF AMERICAN PHYSICIANS j 
MEMBER OF THE AMERICAN PHYSIOLOGICAL SOCIETY ; FELLOW 
OF THE ROYAL MICROSCOPICAL SOCIETY, LONDON, ETC, 


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G. P. PUTNAM’S SONS 


NEW YORK LONDON 
27 WEST TWENTY-THIRD STREET 24 BEDFORD STREET, STRAND 


The Rnicherbocher Press 
1803 


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CopyrRiGuT, 1892 - 
BY 
GEORGE H. F. NUTTALL 


Electrotyped, Printed, and Bound by 
The Rnickerbocker Press, Tew Work 
G. P. Putnam’s Sons 


LL. Sel, ~ ta i AVS 





CONTENTS. 
PAGE 
UTES DEAR ah 0 AAU eae Pop LE a A lA RA 1x 
|S TRAE! WN ANGIE GS le Je ln is a hak ah Pt a I 


Observations of a general character on the sub- 
ject of disinfectants and methods of disinfection. 
What disinfectants, antiseptics, and deodorants 
SUE 2 UE ea ER es aa re 
Agents Used in Disinfection. 

I. Fire, dry heat, moist heat (steam and boil- 
ing water). Objects to which these modes of 
disinfection are applicable. Steam disinfectors, 
their construction, and how they are used....... 

2. Chemical disinfectants. What is required 
in a disinfectant in order that it may be of prac- 
tical use. Certain precautions to be observed in 
Mi neeeiemical disiniectants.. 200.605 sic ee 

Carbolic acid, crude carbolic acid and sul- 
phuric acid mixture, corrosive sublimate, 
permanganate of potash and oxalic acid, 
milk of lime, chloride of lime, sulphur, 


il 


575419 


14 


iv CONTENTS. 


PAGE 


3. Disinfection by means of heat or chemical 
agents .in connection with the mechanical re- 
moval of the infectious agent from various ob- 
jects by means of glutinous brown bread, sponges, 
CLOTHS SCL DDETSHELG. Wu ute boa eel Cee earns 

4. Measures in which false confidence is fre- 
quently placed: ventilation, sunning, airing, and 


22 


beating of infected clothes, etc. Commercial © 


MUsiniectantS ctCvek tc aes ean ete ee ce ee pages a 


PRACTICAL DIRECTIONS. 

Preliminary remarks. The term infectious 
disease defined. The extent to which disinfec- 
tion should be carried out varies in different 
CHSCOSES Ti hs teisiste ao on et eas <i. «ee 

A provisional tabulation of infectious diseases 
in accordance with this fact in three groups, viz.: 
infectious in.the rst, 2drandesdidcoreesi: tae 

I. Precautions to be observed by physicians 
and ‘nurtses inzattendance? on. the«sick:<.ith<eiee 

2. Infectious diseases in private dwellings.... 

3. Regarding the inmates of a house wherein 
existsi.an infectious disease .c.aeee dae, a ee 

Avi Care oi.the sick-teom.s. 2 anurans onc wane 

5. The disposal of infected clothing, bedding, 
etc., in hospitals and private dwellings......... 


24 


27 


CONTENTS. 











Vv 
PAGE 
6. Disinfection of excreta, water-closets, cess: 
SOLES (ACRE Aus oie Sa ttt oes vi FS ie eae Ar Cea te 40 
7. Precautions which should be taken in trans- 
Perineid paticnt, Coa Nhospitale. tae sent. 2s =e 42 
8. The immediate care of the patient’s person 
Spe oa sICkK-TOOMl sass oaks ta erte ee Rig be iene 43 
9g. The disinfection of a room in which an in- 
us Piste oer Nass MIs Ot eer ei deliie ten yee) 40 
ime Menai nleCrionlor isnipst.ic.n aoe y 4.2 50 
11.) The disinfection of’railway cars.....3.... 51 
12. The disinfection of mailsand merchandise. 51 
INFORMATION AS TO THE CAUSE AND MODE OF 
SPREADING OF CERTAIN INFECTIOUS DISEASES, AND 
THE PREVENTIVE MEASURES THAT SHOULD BE RE- 
SORTED TO, ISOLATION, DISINFECTION, ETC.......... 53 
1. Actinomycosis (“big-jaw’”’ of cattle)...... 54 
2. Anthrax (malignant pustule) LRG ea ae 55 
ORE PS et onlay wks ee ia ssa ota « «be 57 
LIMES SIL sEaN @ F aA aes ok FUPRHnN  a 59 
me ysentery (amcebic dysentery) ).. 0.7... 6! 
C0 TEVRS CLIO) ere A ace ae av Sk Sierra oar ee ny eo 62 
POM ref ALC Vinee ex vate erie: bye 36a n nde so) «o's 63 
on, Dagny g eS EINER RS eee ee eM oe | Dea eae 65 
Oem ydrophobia or Rabies... jiaeees.23).. 0: 66 
WOME CLM ety ee eye he 1508 eFee!, $08 ao en ae! Se bate 66 
PROG ee ire sit slaym ceikle gine s nies olea ei 67 


vi CONTENTS. 

PAGE 

12 (Malaria 2h 6 ooo a ateia senes ne Coreen 68 
13. ¢Malionant Ch demahcc uy (nie evar emer s 69 
Taser Mea sles aay ai ibe Di tang oan ated errata Otane 70 
15... Cerebro-spinal Men incitisnes. ia seese eee 70 
16.) Mumps ((epidemic parotitisjiih. ten was: 71 
17.) Pertussis. (whooping-caugh), 25% twee 71 
1SsG APNEUMONIa? Pe cele ok cies ae oe arma een 72 
10.0 Puerperal oF ever joel eer. See ne fie 
20. ., Relapsing Fever (febrisrecurrens) 7 .sece 75 
Zim ohkubellan ROtheln) (0 30 outers 5 cree aee 76 
22 OCALAtinayis bieis yc. oft ha cea in os 76 
2 WEI DOK eras, Shaken o SE SO. aa 78 
24. Suppuration, Septicemia, and Pyzemia.. 79 
Bhat OY DNS Malte ie a ree Oe 81 
20,, 5 Letanus (lockiaw)..2 sss) 6 oe eee 83 
27h Cichinia Sis. chiens. cee a hel 55) 85 
2Rct IAI DEECUIOSIS tis. s be chet. 2. c. e 87 
200) LY Dhold pRevercu ts toe m pe. ee eee go 
20) Gay pOUS ever tne ve iies Our eh ee keh eee Q2 
3 Ie Varicella chickenspox) mech: 9a eee 93 
32, a TY Cllaw Levers. ye. ig tere en roti eee 93 
DUIS LIISUNfECLION seth ie eR eS ee ee 96 


(2) Preparation of the patient for the operation. 
(6) Preparation of the operator and his assist- 


tants; garments worn; sterilization of 
the hands; rubber gloves, 


CONTENTS. aa 


PAGE 
Preparation of the operating table and 
room. 
Disinfection of instruments and vessels. 
Disinfection of dressings and ligatures. 
Disinfectant and sterile solutions em- 
ployed and their method of preparation. 


Mr ay , Ps 
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BREACH. 


N this little book an attempt has been made 

to place in condensed and consultable 
form definite and trustworthy information as to 
the cause of certain infectious diseases, how 
infection spreads, the length of time the spe- 
cific agent may remain virulent, both in a dry 
and moist state and resist thermal and chemical 
disinfection, and putrefaction. Based upon 
such information, measures for the prevention 
of the spread of the disease through isolation 
and disinfection are given. Directions as to 
precautions which are to be observed in par- 
ticular diseases as usually given are vague, 1n- 
adequate, or inaccessible, and, what is more, 
ideas on the subject have of late undergone a 
material change. General principles are laid 
down in a short introduction on disinfectants 


1x 


x PREFACE. 





and disinfection which precedes the more de- 
tailed directions relating to each disease. Only 
such disinfectants and methods of disinfection 
have been considered as have been proved to 
be of practical value. 

A number of authors have been consulted,! 
and the suggestions embodied in their writings 
and such results of experimentation which were 
thought most valuable utilized. It has been 
deemed inadvisable to burden the text with 
quotations. It is to be hoped that the infor- 
mation contained in this book will prove of 
practical value, and that those who may use it 
will give the author the benefit of any sugges- 
tions. 

It may be well to direct attention here 
to the fact, which is much to be regretted, that 
in bringing together for the first time in this 


form the information which we possess on the 


1 Fliigge, Koch, Wolffhiigel, Parkes, Sternberg, Behring, Gartner 
and Plagge, Geppert, Cronberg, Loeffler, Pfuhl, Frankel, Lusk, Fagge, 
Osler, Welch, Halsted, Abbott, Ghriskey and Robb, e¢ aZ 


PREFACE. Abs 


AG ee 








subject of disinfection in its application to vari- 
ous infectious diseases, we are confronted by 
many problems which in the present state of 
our knowledge it is impossible to solve. For 
this reason, in those instances in which it ts 
not possible to give definite directions, recourse 
must be had to general principles of disinfec- 

| tion, such as are laid down in the introduction. 
The writer is indebted to Prof. William H. 
Welch and various other members of The 
Johns Hopkins Hospital Staff for valuable 


su gvestions. 


1G dell ANY 
Ba.timorg, May, 1892. 





HYGIENIC MEASURES IN RELATION TO 
INFECTIOUS DISEASES. 


INTRODUCTION. 
RATIONALLY conducted system of 


disinfection combined in certain cases 
with isolation is one of the most powerful 
means we have of combating infectious disease. 
Disinfection, to be rational, must be conducted 
upon. principles based on a knowledge of how 
the disease is spread, and the peculiarities of 
the specific infectious agent. In certain dis- 
eases, such as smallpox, scarlatina, and measles, 
we as yet do not know the pathogenic 
organism which produces the disease, but we 
know from experience that these diseases can 
be limited if care is exercised, and the more 


accurate knowledge utilized, which we have 


I » 


2 HYGIENIC MEASURES 


—=> 








gathered from the study of certain known dis- 
ease agents (pathogenic bacteria) and their 
behavior towards disinfectants. 

As these tables may fall into the hands 
"of persons not especially acquainted with the 
subject, it may not be out of place to make 
the following observations: By the term dis- 
enfectzon 2s meant the absolute destruction of tn- 
fectious materzal, and this is not accomplished 
by other agents than disinfectants, which must 
not be confounded with antiseptics and deo- 
dorants. A duzsenfectant kills the disease 
agent or putrefactive organism, and _ neces- 
sarily has some of the qualities of an antisep- 
tic and deodorant. (Many preparations sold 
as disinfectants are nothing of the kind, but 
may belong to the following classes.) Az 
antiseptic arrests putrefaction or fermentation, 
but does not kill the micro-organisms, whilst a 
deodorant is used to destroy bad odors from 
cesspools, stables, discharges, etc. We have 


IN RELATION TO INFECTIOUS DISEASES. 3 


——— 





in copperas (sulphate of iron) an excellent 
antiseptic and deodorant, which can unques- 
tionably be of great service ; for example, in 
epidemics, where a larger amount of decom- 
posing matter requires treatment than it is 
practicable to disinfect. It is of the greatest 
importance that these various agents should 
not be confounded. 


AGENtS USED IN DISINFECTION. 


We can disinfect by means of fire, dry heat,. 
moist heat (applied as steam or boiling water), 
or by various chemical agents,and, besides this, 
we can combine the action of disinfectants 
with the mechanical removal of infectious 
material, by means of brushes, sponges, 
cloths, etc. We will now consider the various 


agents above named. 


DISINFECTION BY MEANS OF FIRE. 


The simplest and most effectual means of 


destroying infectious material is by burning 


4 HYGIENIC MEASURES 








it. This method of destruction being only 
applicable to worthless articles, has but a 
limited application as far as contaminated 
objects are concerned. On the other hand, 
sputa (especially tuberculous sputa on rags or 
paper, etc.), faeces (mixed with saw-dust), and 
wound dressings, etc., soiled with discharges, 
can be very readily and satisfactorily disposed 
of through the agency of fire. 


DISINFECTION BY MEANS OF DRY HEAT. 


Disinfection by means of dry heat has but a 
limited application. Articles to be disinfected 
must be exposed longer to the action of dry 
than to that of moist heat, and in consequence 
many animal and vegetable fabrics are injured. 
Dry heat penetrates so slowly that even after 
an exposure of three to four hours at 140° C. 
[284° F.] (Koch and Wolffhigel), compara- 
tively small bundles of clothing, etc., are not 
thoroughly penetrated by the heat. Vegeta- 


IN RELATION TO INFECTIOUS DISEASES. 5 











tive forms of bacteria are killed by dry heat 
at a temperature of 100° C. (212° F.), usually 
inside of one hour and a half, whilst spores, as 
a rule, are only destroyed by a temperature of 
140° C. (284° F.), maintained for three hours. 
If bedding, clothing, etc., are exposed to this 
latter temperature with any degree of fre- 
quency, for example, in hospitals, the fabrics 
are rendered much less durable. It has been 
shown that woollen fabrics change color after 
two hours at 105°C. [220° F. | (De Chaumont); 
that cotton and linen are affected after two 
hours at 125° C. [257° F.] (Vallin). It is diff- 
cult to control the temperature when dry heat 
is used, unless it be derived from compressed 
steam acting through iron pipes, etc. Vermin 
are destroyed completely after an exposure 
of but a few minutes to dry heat at a temper- 
ature of 105° C (220° F.), and in less than an 
hour at that temperature they are quite brittle 


and fall to pieces (Lake). Objects which 


6 HYGIENIC MEASURES 








have been exposed to dry heat should be 
allowed to regain their hygrometric water (so 
as to insure against loss of substance) before 
being beaten or brushed (Vallin). Dry heat 
is useful in connection with steam disinfection, 


as will presently appear. 
DISINFECTION BY STEAM AND BOILING WATER. 


By means of steam at 100° C. (212° F.) 
and boiling water, we are able to thoroughly 
disinfect a number of articles which other- 
wise would be awkward to manage. We are 
dealing here with the most useful and relrable 
agent we know, as, on the one hand, it cannot be 
neutralized, as chemical disinfectants frequent- 
ly are, and, on the other, the most delicate 
fabrics can without injury besterilized by means 
of steam, provided certain precautions are taken. 

Disinfection by Steam. For this purpose a 
variety of steam disinfectors have been de- 


vised. The simplest, which might be of 


IN RELATION TO INFECTIOUS DISEASES. i 





service in an emergency, is suggested by 
Fligge ; that is, one made of a cask with one 
end perforated and the other knocked out, 
placed with the perforated end uppermost 
over a vessel of boiling water. The objects to 
be sterilized or disinfected can be placed ona 
kind of framework within the barrel, and the 
escape of steam from around the base of the 
latter prevented, to a large extent, by wrap- 
ping cloths aboutit. Such a home-made steam 
disinfector could be used several times, but, of 
course, would not be durable. The same in 
principle, but provided with a conical top to 
prevent the water of condensation from falling 
on the contained objects, are the ordinary 
steam sterilizers (made of iron or tinned 
copper) employed in our bacteriological labor- 
atories. An improvement on these, the 


1 


«“ Arnold steam sterilizer,’ is useful for the 


1 This most excellent and inexpensive apparatus is manufactured by 
Wilmot Castle, & Co., Rochester, N, Y, It is made either of heavy 


8 HYGIENIC MEASURES 








sterilization of small objects, bandages, instru- 
ments, etc. When, however, we come to con- 
sider what a variety of objects, small and large, 
it is necessary to disinfect in infectious dis- 
eases, we realize the necessity of larger steam 
sterilizers, and their equipment with a number 
of arrangements to increase their convenience. 
We will presently see what objects should and 
should not be disinfected by steam. 

Hospitals and public institutions for disinfec- 
tion should be provided with capacious steam 
disinfectors. A number of these have been 
suggested or patented, but they are all based 
on /the)same: principle > «hey best stoma 16 
tubular, either circular or oval on cross-section, 
passing through a brick wall separating two 


rooms. The disinfector has two doors, one 


tin with copper bottom, or entirely. of copper; the former, of course, 
being considerably cheaper. The sterilizer can be heated over an 
ordinary stove, or by means of a gas, alcohol, or kerosene flame. 
The largest size is 1114 inches in diameter, and 12% inches in 
height. 


IN RELATION TO INFECTIOUS DISEASES. 9 





opening into each room, the infected objects 
being introduced by the one and removed by 
the other. The walls of the tube are double, 
so that steam, superheated if necessary, can be 
admitted into the steam-jacket thus formed, 
and heat the objects within the tube without 
steam being admitted into the inner chamber. 
By this arrangement one can apply dry or 
moist heat to the objects inside. It is desira- 
ble to first apply the heat (dry) through the 
jacket until the objects inside reach the tem- 
perature of 100° C. (212° F.), as this prevents 
the steam, which is then let into the chamber, 
from condensing on the contained objects. 
This is very important. By means of properly 
arranged tenting, or thin metal plates arranged 
on the inside of the disinfector somewhat like 
shingles on a roof, but with large spaces be- 
tween them, any water which may condense 
at the top of the sterilizer is prevented from 


dripping on the objects, and runs down with- 


IO HYGIENIC MEASURES 





out injuring them to the floor of the chamber. 
The steam disinfector is covered on the out- 
side by woodwork and asbestos to prevent 
loss of heat. By means of such a steam disin- 
fector as this we are also able to utilize steam 
under pressure, both in the steam-jacket and 
inner chamber, thus increasing the rapidity of 
the process. To be properly conducted, two 
employees should have charge of the disin- 
fector, and two easily cleaned oil-painted carts 
should be used, the one for the transportation 
of the infected, the other for disinfected 
articles. Such carts can be painted of dif- 
ferent colors, so as to be easily recognized. 

It is best to have a separate building of 
small size devoted solely to this purpose, and 
consisting of two rooms, each with separate 
entrances, one for the handling of infected, 
the other for disinfected articles, and a third, 
if necessary, for an engine-room. The man 


in charge of the objects to be disinfected 


WV TRE EA TION TO INFECTIOUS DISEASES. II 


——— 





should be provided with a skull-cap, overalls, 
and blouse of canvas or linen, and rubber 
boots, the same to be disinfected at short in- 
tervals. Before removing the outer clothes 
he has worn whilst handling infectious ob- 
jects he should wipe them off with a sponge 
moistened with carbolic acid solution, and 
after removing them disinfect the hands and 
face. 

Articles such as clothes, blankets, etc., 
should be hung up in the steam disinfector, 
not put in rolled up, and towels and mattresses 
(the latter ripped open in certain cases) so 
arranged as to leave space between the objects, 
so as not to prevent the heat or steam from 
penetrating. In some steam disinfectors, 
proper racks and wire baskets are provided in 
which to place the things to be disinfected. 

The length of time articles should be exposed 
to the action of steam. The time required for 


the disinfection of various articles by means of 


12 HIYGIENIC MEASURES 


steam differs according to their bulk, the larger 
the object the longer it takes steam to pene- 
trate it. The time is calculated from the 
moment the air has been expelled’ from the 
chamber (this is most rapidly accomplished 
when the steam enters from above and drives 
the air out below), and an electric pyrometer 
or thermometer informs us that the tempera- 
ture has reached 100° C. (212° F.) or more, de- 
pending upon whether we use steam under 
pressure or not. If the objects are bulky, we 
place the thermometer within them, so as to 
know when the heat has penetrated. We can 
feel sure of small objects being disinfected in 
half an hour at 100° C. (212° F.), whilst more 
bulky objects should be exposed one to two 
hours. When a temperature of 110° to 120° 
C. (230° to 248° F.) (steam under pressure) 


is used, five to ten minutes will do for small 


! Gruber’s experiments showed that the presence of air in a steam 
sterilizer prevents the effective action of steam, 


IN RELATION TO INFECTIOUS DISEASES. 13 





objects, and fifteen to thirty minutes for 
large.’ < 

Disinfection by steam ts applicable to clothes, 
linen, blankets, towels, carpets, curtains, and 
a variety of delicate fabrics, mattresses and 
pillows (ripped open if bulky), letters, etc. 
Disinfection by steam ts not applicable to linen 
soiled by blood, pus or feces, as the stain be- 
comes fixed. Fliigge advises placing such 
objects (which should be contained in bags) 
twenty-four hours in a disinfectant solution 
(sublimate and salt), and then wash them off 
with a stream of water before sending them 
to be washed. Steam cannot be used, more- 
over, for the disinfection of objects made of 
leather or rubber, hair-brushes, combs, etc. 
These should be disinfected by washing or 
soaking in carbolic solution, and afterwards be 


well washed in soap and water. 

1 Without doubt pathogenic organisms are often killed by shorter 
exposures than those here given, but it has been deemed advisable 
to err on the safe side. 


14 HYGIENIC MEASURES 








Disinfection by botling. The articles to be 
cleansed‘ should be boiled or disinfected be- 
fore being sent to the laundry. Boiling for 
fifteen to thirty minutes will certainly kill all 
infectious agents. If the articles are dirty, or 
soiled by fatty or slimy matter, sputa, etc.; two 
per cent. of sal soda (commercial sodic carbo- 
nate) should be added to the water in which 
they are boiled. 


CHEMICAL DISINFECTION. 


Certain matters to be remembered in connec- 
tion therewith. It must be remembered thata 
definite quantity of disinfectant is needed, as it 
becomes exhaustedin action. In other words, 
the disinfectant must act in a certain concen- 
tration upon the infectious material, and must 
penetrate the latter. Depending upon each 
case, we must allow the disinfectant to act a 


1 The ordinary treatment to which soiled linen and clothes are 
subjected in the laundry (one half hour’s boiling) would be quite 
sufficient for their disinfection were it not for the fact that the process 
of boiling is preceded by the processes of sorting, soaking, and rinsing 
in cold water (Fliigge). 


IN RELATION TO INFECTIOUS DISEASES, 15 


longer or shorter time. The higher the tem- 
perature, the more markedly is the power of a 
disinfectant increased. The germicidal power 
of a disinfectant varies with each organism, 
depending in certain cases upon whether it ts 
present in the spore (resistant) or vegetative 
(less resistant) stage, and the activity of a dis- 
infectant varies also with the conditions under 
which the disease agent is encountered. In 
this way, dryness of the object to be disin- 
fected (for example, in the case of tuberculous 
sputa) will not allow the disinfectant to pene- 
trate, or steam to act as promptly. Again, 
much organic matter will neutralize the action 
of many disinfectants. | 

What ts destrable in disinfectants in prac- 
tice. A disinfectant, to be applicable in prac- 
tice, must not only stand the severe test of the 
laboratory, made with a view to its effective- 
ness under conditions similar to those nor- 
mally found, but also it must be inexpensive 
and not dangerous to handle. Further, it 


16 HYGIENIC MEASURES 


should neither become easily altered in its 
chemical composition, have a bad, strong 
or lingering odor, nor injure articles to 
which it is applied. It is not essential that 
the disinfectant shall fulfil the severe test 
made on highly resistant bacterial spores if we 
can assure ourselves of the fact that the infec- 
tious agent is killed by a less powerful germi- 
cide. This matter can only be determined by 
exact experiments. With a view to their 
application in practice, only those disinfectants 
which answer the requirements above stated 
will be found in these tables. 

Carbolic actd has the advantage over cor- 
rosive sublimate in that it is not so readily 
decomposed, does not attack instruments, and 
has a characteristic, not disagreeable odor, 
which makes it safer for general use. It is 
used in the concentrations of three and five 
per cent. 


Crude carbolic acid, to whitch ts added an 


IN RELATION TO\INFECTIOUS DISEASES. 17 








egual volume of concentrated sulphuric acid 
(Laplace, Fraenkel), the undissolved parts of 
oily consistency being removed by filtration, 
is most effective, more so than pure carbolic 
acid for the disinfection of excreta, etc. 
(N.B.—To be kept artificially cool when being 
mixed. ) 

Corrosive sublimate (solutions 1 to 500, I 
to 1,000, I to 2,000) is precipitated by albu- 
minous substances, and counteracted in pro- 
portion to the amount of the latter with which 
it comes in contact. The precipitated albu- 
minate of mercury is re-dissolved in an excess 
of albuminous fluid and acts as a germicide 
when not prevented from penetrating, which 
it is, however, in practice; for example, by the 
surface coagulation which takes place on 
masses of organic matter such as occur in 
feces and sputum. Sodium and potassium 
chloride added in the proportion of five to 
one to the sublimate in solution prevents the 


2 


18 HYGIENIC MEASURES 








coagulation above mentioned, as also the 
action of light from producing alterations in 
the sublimate. 

As an application to wounded surfaces, 
though very frequently employed, it cannot 
but be looked upon as practically useless and 
directly injurious: useless, as the concentration 
in which it ought to act is lessened by contact 
with albuminous substances; injurious, as it 
counteracts the natural germicidal power of 
the blood, and creates a greater tendency to 
wound-infection through the formation of a 
layer of necrotic cells wherever it comes in 
contact with living tissue, thus lessening the 
resistance of the part. (Welch.) 

Permanganate of potash combined with oxalic 
acid. Solutions of permanganate of potash 
and oxalic acid used warm, as described below 
in connection with surgical disinfection, have 


given the best results in hand disinfection 


(p. 97). 


IN RELATION TO INFECTIOUS DISEASES. 10 


—— 








Milk of lime, applied as whitewash to walls. 
The value of this old method of purifying the 
walls of apartments after infectious diseases 
has been demonstrated by Jaeger’s experi- 
ments, where those organisms were chosen as 
tests which are most likely to be encountered 
in the disinfection of stables (including J. 
anthracis, the glanders bacillus and the Staphy- 
lococcus pyogenes aureus), the bacillus tuberculo- 
sis being the only one not affected inside of 
twenty-four hours byacoat of whitewash applied 
over the surface on which it had-been placed. 

Applied in the disinfection of excreta. In 
milk of lime we possess the most valuable 
agent for the disinfection of typhoid and 
cholera stools. This agent is prepared as 
follows: to unslacked lime, placed in a stone 
jar or wooden trough, as much water as it will 
absorb is carefully added. The slacked lime 
is stirred up with four parts of water to form the 


milk of lime, and this is mixed intimately with 


20 HYGIENIC MEASURES 





¥ 


the discharges until the mixture gives a strong 
alkaline reaction (tested by litmus paper). 
Owing to the varying age and frequent im- 
purity of lime, it is better to trust to the litmus 
test (Pfuhl) than to add a certain proportion 
of milk of lime to the discharges. It does 
not do to add unslacked lime to discharges, as 
the pieces of lime are only slowly affected, and 
in consequence the action of the lime is tardy 
and weak. We cannot afford the delay, and 
it should only be used when an opportunity 
for slacking lime is not immediately at hand. 

Chloride of lime to be effective must con- 
tain twenty-five per cent. of available chlorine. 
Its {cost 1s “Small isisxc oltineess to. tie gallon 
of water representing the standard solution 
recommended by Sternberg. 

Sulphur. Twenty grammes are to be 
burnt to the cubic metre of room space.’ The 
sulphur is moistened with alcohol before 


1 Three pounds to one thousand cubic feet recommended by the 
Committee on Disinfectants, A. P. H. A., 1888. 


VV MeL ALION  LO'NFECTIOUS ! DISEASES. ~ 21 





ignition, and all the apertures leading out of 
the room closed. By the burning of sulphur, 
sulphurous acid is evolved (H,SO,), which 
attacks organic matter on account of its 
affinity for oxygen, combined with which it 
forms sulphuric acid (H,SO,), and to the 
latter is really due the greater part of the 
destructive effect. It has been experiment- 
ally shown (Wolff hiigel and Koch) that only 
the surface of exposed articles is affected, 
and that it is practically impossible to attain 
a proper degree of concentration. The burn- 
ing of sulphur in the presence of moisture 
is effectual, but fabrics are destroyed thereby, 
and metal surfaces attacked. Though sulphur, 
as generally employed, has not stood the test in 
relation to pathogenic bacteria, there is some 
evidence that it may affect other disease agents 
of a more susceptible nature. On account of 
the heat evolved by the burning sulphur, the 
vessel containing the latter should be placed 


in a basin or vessel containing water, 


22 HYGIENIC MEASURES 





The fact that a disinfectant must act ina 
certain concentration and penetrate to be 
effective demonstrates the utter absurdity of 
ozone-lamps, or the dropping a little carbolic 
acid solution into privies, etc., as also the use 
of this agent when placed in dishes about the 
room, or when used to moisten suspended 
cloths,,or as a spray intended to purify the 
atmosphere. Regarded in this light, the 
burning of sulphur, as generally done, must 


frequently be useless. 


THE MECHANICAL REMOVAL OF THE DUST OR 
INFECTIOUS AGENT FROM WALLS, FURNI- 
TURE, ETC., BY “MEANS, OF  °GLUTINOUS 
BROWN BREAD, BRUSHES, SPONGES, SCRAP- 
ERS, MOIST CLOTHS, ETC., IN CONJUNCTION 
WITH DISINFECTION BY MEANS OF HEAT 
OR CHEMICAL AGENTS. 


The dust which has settled on various 


objects in the sick-room is to be removed 


UNO EL LON LT OUNEFECTIOUS DISEASES. 23 








daily by means of a cloth moistened with 
Branionide 1 (1) \to .1,000)",)- Dusting as). it 
is usually done in private houses simply 
scatters the dust from one place that it may 
settle in another. Sponges can also be used 
for the removal of dust if they are frequently 
wrung out in a disinfecting solution; it 
has been experimentally demonstrated. that 
sponges are most efficient for this purpose. 
The use of scrubbers, etc., see p. 47. 

Glutinous brown bread for the removal of 
the pathogenic organisms from the walls and 
surfaces of polished furniture, etc., was recom- 
mended by von Esmarch, in 1887. Experi- 
mentally it gave the best results—that is, it 
removed the organisms very well from various 
surfaces over which it was rubbed, the micro- 
organisms being enclosed in or sticking to the 
little pellets of bread that are formed in the 
process of rubbing. Bread has the advantage 
of not being dangerous to the persons 


24 HYGIENIC MEASURES 





employed, etc., or injurious to papered or 
painted walls... The) directions -arenthat the 
walls be rubbed for at least the height of a 
man, and the crumbs which fall to the floor 
burnt. The success of this method depends 
on the conscientiousness of those engaged in 
the disinfection, and it has also other objec- 
tions. The bread is not inexpensive; it must 
not be too dry nor too moist; small particles 
adhere to the wall, and may subsequently fall 
to the floor, be trodden on, and be converted 
into dust, and the disease agent thus liberated 
again. Bread is certainly not applicable to 
walls where crevices and cracks occur, or to 
others than such as have a smooth surface. 
See further p. 47. 


MEASURES IN WHICH FALSE CONFIDENCE IS 
FREQUENTLY PLACED. 


Ventilation. It has for a long time been 
considered probable that the ventilation of 


ENE LLAILON (10) TNFECTIOUS: DISEASES. 25 








the sick-room diluted any infectious agent 
floating in the air, but nothing short of a good 
draught will accomplish this, according to the 
experiments of Stern, which, moreover, show 
that strong currents of air would have scarcely 
any effect in reducing the number of organisms 
once they have settled on the floor or objects 
in the room. 

Sunning, beating, and atring of infected 
articles. Sunlight has been shown, experi- 
mentally, to kill the resistant spores of the an- 
thrax bacillus, as also the bacillus tuberculosis, 
in a few hours. However, this agent would 
not do in practice, as it only acts on the im- 
mediate surface of infected objects. Beating 
and airing are not to be relied on for the 
removal of the infectious agent, as the latter 
adheres too closely to various fabrics, especially 
flannel, etc., tobe removed by any mechanical 
process (Stern); and even though a vacant lot 


may be chosen for beating and brushing of 


26 HYGIENIC MEASURES. 








the”-infected: articles, ‘themintection may pe 
spread thereby, and those engaged in the beat- 
ing are greatly exposed. See further p. 36. 
Commercial disinfectants are, as a rule, un- 
reliable, having usually only the qualities of 
antiseptics or deodorants, besides being, as a 


rule, expensive. 


PRACTICAL DIRECTIONS 
PRELIMINARY REMARKS, 


ji infectious disease is one which is caused 

by the invasion and multiplication 
within the body of pathogenic organisms 
derived from various sources. 

In the following pages we shall consider only 
such infectious diseases as are due to patho- 
genic mzcro-organisms, and particularly those 
to which a system of disinfection should be 
applied. We shall describe as contagious such 
infectious diseases as are directly or indirectly 
communicable from one person to another. 

The extent to which disinfection should be 
carrted out varies in different infectious dis- 
eases, and it seems advisable from this point 


of view to classify those where disinfection is 
27 


28 HYGIENIC MEASURES. 





usually practised, even though it be provision- 
ally in accordance with our knowledge of how 
disease spreads, and the peculiarities of the 
specific infectious agent. The following table 
represents such a provisional classification, the 
diseases being grouped in three columns, ac- 
cording to the degree of infectiousness which 
characterizes them. Several diseases, about 
which insufficient knowledge exists, have been 
omitted from the table. 

At first sight tuberculosis may appear mis- 
placed, but by referring to page 87, where we 
speak of this disease and how it is spread, 
we see the necessity of careful and complete 
disinfection, especially in the houses of the 
poorer classes, where the habit of careless 
expectoration on carpets and floors is par- 
ticularly prevalent. The slow development of 
the disease, and the fact that a large number 
of persons are apparently immune, disguises 


greatly the degree of infectiousness which 


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30 HYGIENIC MEASURES. 





tuberculosis possesses, and, though susceptible 
individuals may be in the minority (we cannot 
say in advance who are and who are not sus- 
ceptible), it is our duty to protect them by 
every Means in our power. 

As far as practicable we should deal with the 
wnfecttous agents at their point of orzgin and 
under all circumstances act promptly. By pro- 
ceeding in this way we have the best chances 
of limiting the disease. In the acute exan- 
themata we prevent the diffusion of the infec- 
tious agent by means of applications of fatty 
substances to the skin, and by combining a 
disinfectant with the application we perhaps 
lessen its virulence. Gargles and washes of 
dilute disinfectants have the same effect. We 
should disinfect promptly, as we know in cer- 
tain cases that the infectious agent is capable 
of multiplying outside the body, and in conse- 
quence the longer we wait the greater may be 


the amount of infectious agent we have to 


IN RELATION, TO INFECTIOUS DISEASES, 31 





deal with. If we wait too long insects may 
have an opportunity of gaining access to ves- 
sels containing excreta, etc., and act as car- 
riers, or through desiccation an opportunity is 
given the infectious agent to becomescattered 
about as dust. We know that moist surfaces 
will not permit the diffusion of infectious 
agents. Lastly, it is desirable always to use a 
chemical disinfectant in a sufficiently concen- 
trated form, or heat for a long enough period, 
to exclude all possibility of the disinfection 


not being complete. 


PRECAUTIONS TOP SE OBSERVED" BY PHYSICIANS 
AND THOSE, IN: ATTENDANCE ON <THE SICK. 


ane physician should watch his movements 
in the sick-room, avoiding, as much as possi- 
ble, all contact with objects about the patient, 
as well as the patient himself. He should 
avoid sitting on the bed, and should not wear 
clothes to which dust or infectious matter can 


32 HYGIENIC MEASURES 





——— 


readily adhere; in fact, it is advisable, and in 
some hospitals customary, for him to draw on 
a long linen duster before entering the sick- 
room. Such dusters should be disinfected by 
boiling or steam sterilization, or be sponged 
off with carbolic acid solution at stated inter- 
vals, and it would be well to keep several 
hanging on pegs outside the hospital wards for 
infectious diseases. After handling the patient 
or touching anything about him, the physician 
should disinfect his hands in a basin of three- 
per-cent. carbolic solution, which, together with 
a nail-brush, should be kept constantly on hand 
in the sick-room, or an ante-chamber leading 
thereto.’ Clinical thermometers and all instru- 
ments should also be disinfected in carbolic 
acid immediately after being used. 

The nurse or attendant on the patient 


should observe the same precautions as the 


1 Under certain circumstances, especially when handling infected 
dressings, the use of rubber gloves, which are kept soaking in a dis- 
infectant solution, is to be recommended. 


IN RELATION TO INFECTIOUS DISEASES. 33 


~—— 





physician. Nurses presumably immunified 
by having had the particular disease them- 
selves are to be preferred. They should be 
isolated with the patient, and be clothed in 
linen or some other material which can be 
washed and starched and will not convey 
the infectious agent. The nurse’s clothing 
should be washed with as many precautions 
as that of the patient. Other measures than 
those here mentioned will be found on p. 73, 


under puerperal fever, etc. 
INFECTIOUS DISEASES IN PRIVATE DWELLINGS. 


It is almost impossible to successfully isolate 
individuals suffering frdém infectious diseases 
in private houses, and to carry out a proper 
system of disinfection under conditions where 
ignorance, sloth, or poverty exist. Even in 
the houses of the better classes it is generally 
impracticable to do what ought to be done 


on account of indifference to consequences, or 
3 


34 HYGIENIC MEASURES 


(a 2 ene Y 





false ideas of economy. Nevertheless it is 
necessary to do all that can be done in each 
case, and this must be determined by the con- 
scientious physician. When practicable a 
room or apartments at the top of the house 
should be chosen in which to place the invalid. 
All superfluous objects (curtains, carpets, 
hangings, pictures, ornaments, etc.), which are 
liable to catch the dust should be removed, 
only what is absolutely necessary for the 
patient’s comfort being left in the room. It 
is desirable that good .ventilation be main- 
tained by means of an open fireplace, or other 
arrangement by which the air of the room can 
be caused to pass directly out into the open 
air through the chimney or window. A sheet 
kept constantly moistened with carbolic acid 
and glycerin, or with chloride of lime solution, 
can be tacked outside of the door which opens 
into the sick-room, making it necessary to 
push it to one side in going in and out of the 


IN RELATION TO INFECTIOUS DISEASES. 3° 





room, thus making the isolation more perfect. 
As moisture, darkness, and a low temperature 
permit the infectious agent to retain its 
virulence longest, it is advisable to guard 
against infected clothing, soiled linen, etc., 
being thrown into dark corners, cellars, or 
trunks. Damp, dark houses should be heated 


and ventilated as well as possible. 


REGARDING THE INMATES OF A HOUSE WHERE- 
IN EXISTS AN INFECTIOUS DISEASE. 


All children belonging to a family where an 
infectious disease has occurred should be pre- 
vented from attending school for a longer or 
shorter period, as will be seen on reference to 
pages 60, 72, etc. Jacobi wisely suggests that 
provision should be made for the removal of 
healthy children from infected houses to 
sanitaria, so as to guard against their contract- 


ing the disease. 


36 HYGIENIC MEASURES 





CARE. OF “THE SICK-ROOM: 


No beating or brushing of clothes, or dust- 
ing should be done in the sick-room, but all 
dust should be removed daily from places 
where it may have lodged, by means of a cloth 
moistened with disinfectant (see p. 47). In 
this way, window-sills, furniture, and floor’ 
should be kept perfectly clean. Visitors, as 
far as possible, should be excluded, and the 
isolation of the patient continued until con- 
valescence is well established, or death has 
occurred. The presence of insects in the 
sick-room should be guarded against as 
much as possible, in view of the fact that 
they may act as carriers of disease. No 
foods should be allowed to stand about 
uncovered, or for any length of time in the 
room, as in certain cases pathogenic organ- 

1 Though wet tea-leaves and saw-dust are excellent for the removal 


of dust from floors in the ordinary routine of domestic life, they can- 
not be recommended in the sick-room. 


IN RELATION TO INFECTIOUS DISEASES. 37 








isms may gain access to them and multiply 
therein. Nothing should be removed from 
the room without being first disinfected, or 
wrapped in a cloth moistened with disin- 
Peecant, in. which it 1s carried (to a proper 
spot to be disinfected. The slops (the water 
used for washing the patient, linen, etc.) 
should always be disinfected. 

The floors of a_ sick-room or hospital 
ward should be rendered impervious. In 
the Johns Hopkins Hospital they have 
hitherto been treated as follows: Eight 
ounces of paraffin are dissolved in one gallon 
‘of turpentine, and the solution applied to 
the floors with a mop. The floors are then 
rubbed over with a stiff-haired brush loaded 
with lead. Such floors can be kept very 
clean from dust and can be readily disin- 
fected. In other hospitals melted paraffin has 
been applied to the floors to render them 


impervious. 


38 HYGIENIC MEASURES 





THE DISPOSAL OF INFECTED CLOTHING, BEDDING, 
ETC., IN HOSPITALS. AND» PRIVATE DWELLINGS, 


Unless soiled with discharges, infected 
clothing, towels, bedding, linen, blankets, etc., 
are best rendered harmless by steam steriliza- 
tion or boiling. When about to be removed 
from the room, such articles should be received 
at the bedside into a covered vessel containing, 
if necessary, some carbolic solution, or should 
be folded up in a sheet moistened with disin- 
fectant (sublimate 1 to 2,000). In this way 
the infectious agent will be confined whilst 
the objects are being transferred to sacks in 
which they are sent to the disinfector. A 
convenient form of chute for infected clothing 
intended for use in hospitals, has, at the 
writers suggestion, been put into operation 
in the Johns Hopkins Hospital.’ The chute 
terminates in a stout canvas bag, in which the 
objects should be directly transferred to the 

1 See Yohns Hopkins Hospital Bulletin for April, 1892. 


IN RELATION TO INFECTIOUS DISEASES.'| 39 


disinfector on a cart of simple construction 
and oil-painted. Two carts should be used, 
differently numbered or painted, the one for 
the infected clothing going to, and the other for 
the disinfected clothing coming away from, the 
disinfector. The advisability of a steam dis- 
infector passing through the wall between 
two rooms, the one for the reception of the 
Miectccs sinemotherstorwne) delivery -of the 
disinfected, clothing, has already been con- 
sidered. Infected articles in private houses 
should be disinfected on the spot, or after being 
properly enveloped carried to some public in- 
stitution, which will attend to their proper dis- 
infection. Such objects should on no account 
be sent to cleaning establishments or laundries. 
No time should be lost in having the clothing, 
etc., disinfected, as if laid aside they may be 
forgotten and, the proper conditions for the 
maintenance of the infectious agent existing, 


an oversight may lead to grave consequences, 


40 ’ HVYVGIENTO \MEASORES. 








wz 


DISINFECTION. OF |. EXCRETA, WATER-CLOSETS, 


CESSPOOLS, ETC; 


E-xcreta (Sputa, Urine, and Feces ). 


Sputa are best disinfected by steam ster- 
ilization, together with the sputum cups. 
The addition of fifteen grammes of sal-soda to 
the litre of water materially aids the process 
of cleaning. A small disinfector with a suit- 
able rack for sputum-cups has been suggested 
for this purpose in hospitals (Kirchner), and 
should certainly be put into general use. The 
disinfection should take one half hour—that is 
to say, the sputum should be exposed to the 
action of steam for one half hour at 100° C. 
(erent): 

Urine and feces are best treated together 
by means of milk of lime, prepared as given 
on p. 19, and added in sufficient quantity, so 
that after being well mixed with the stools, a 


strong alkaline reaction is obtained, as tested 


IN RELATION TO INFECTIOUS DISEASES. 4I 





by litmus paper (Pfuhl). Allow the vessel to 
stand one hour, or if it be desired sooner, 
empty it after not less than fifteen minutes, 
and rinse it out well with fresh milk of lime. 

A quart of chloride of lime solution (four 
ounces to the gallon) added to each typhoid 
stool is recommended by Sternberg. The 
solution must be fresh and contain twenty-five 
per cent. of available chlorine. 

Carbolic acid (unless in combination with 
sulphuric, as given on page 16) and corrosive 
sublimate are not suitable for the disinfection 
of stools. The strong mineral acids can be 
used in pits where the discharges have been 
thrown. Discharges can also be disposed of 
by burning after admixture with sawdust, etc. 

Water-closets are best disinfected by chlo- 
ride of lime solution, or five per cent. carbolic 
acid ; cesspools by chloride of lime or prefer- 
ably milk of lime added in the manner above 
stated. 


42 HYGIENIC MEASURES 





PRECAUTIONS (WHICH "SHOULD “BE TAKEN} IN 
TRANSFERRING AY PATIENT) (TO) A | HOSPITAL, 


The most criminal negligence exists in this 
respect. The transfer of a patient suffering 
from an infectious disease to a hospital should 
be combined with proper disinfection of the 
apartments he has occupied. He should be 
cared for by a reliable person sent by the hos- 
pital, and the patient, properly covered with 
sheets moistened with dilute disinfectant, be 
transported to a suitable vehicle and by this 
means brought to the hospital. Public vehi- 
cles of any sort should not be used. The 
vehicle in which the patient is transferred to 
the hospital should be properly constructed 
for the transfer of the sick on a cot, and be 
oil-painted on the inside, so as to facilitate 
disinfection after each journey. On arrival 
at the hospital and before admission to 
the wards the patient should, under all con- 
ditions, when practicable, receive a bath, and 
the clothing in which he has been admitted 


IN RELATION TO INFECTIOUS DISEASES. 43 





should always with proper precautions be dis- 
infected. A special department for the recep- 
tion of patients should exist in every hospital 
provided with rooms for undressing, bath- 
SOOniswetc. 

Public institutions for disinfection should 
exist in every community, being properly off- 
cered and having competent intelligent men 
to do the work. The disinfection of dwell- 
ings as carried out by our State Health De- 
partments in different parts of this country is 
often utterly absurd and inadequate. A reg- 
Maveeservice ot intellisent) trained’ men .is 
what is necessary. Steam disinfectors on 
wheels can be employed in certain districts ; 
otherwise one such as is described on page 7 


will answer all purposes. 


THE IMMEDIATE CARE OF THE PATIENT'S 
PERSON IN THE SICK-ROOM. 


Everything that has had an opportunity of 
directly or tndtrectly coming tn contact with the 


44 FIYGIENIC MEASURES 


———_ 





enfecttous agent should be treated as infectious 
matter. 

The bedstead should be of iron with a 
spring mattress, supporting a mattress that is 
not too soft, and the latter, as also the pillows, 
in cases where discharges occur should be 
protected with rubber sheets. Tarnier has 
recommended _ tarred paper to protect the 
mattress under certain circumstances. The 
bed and bed linen should be renewed as soon 
as soiled. The person of the patient should, 
of course, be kept as clean as possible. In 
the exanthemata the application of fatty sub- 
stances to the skin will prevent, to a large 
extent, the diffusion of epidermal scales. 
When the fecal discharges are soft or occur 
in bed, toilet paper followed by compress- 
cloth or clean soft rags moistened with dilute 
disinfectant (carbolic acid three per cent.) 
should be used to clean the nates, and these 


rags disinfected together with the contents of 


IN RELATION TO INFECTIOUS DISEASES. 4% 





the bedpan or other receptacle. Clean rags 
should also be used for wiping discharges 
from the nose or mouth, and are best gotten 
rid of by burning. Wound dressings and 
bandages can be disposed of in a like manner. 
The eating utensils used by the patient should 
be kept for his use alone, and be boiled in 
water containing sal-soda for fifteen minutes, 
and afterwards be rinsed in pure water. All 
food and drink returning from the sick-room 
should not be touched by others. Books or 
toys or other objects much used by the patient 
should be of little value and burnt when 
the time for general disinfection has arrived. 

-Convalescence.—In the succeeding pages will 
be found directions concerning the precautions 
which should be taken during the period of 
convalescence. Fligge recommends that be- 
fore the patient leaves the sick-room, when 
convalescence is well established, he should 


take a bath, then wash his hands, forearms, 


46 HYGIENIC MEASURES 





ae 


face, and hair with sublimate solution, and, 
after having put on clean clothes and left the 
room, remove the sublimate. 

The Corpse.—\mmediately after death the 
body should be enveloped in a sheet moistened 
with five per cent. carbolic acid, or, as recom- 
mended by Sternberg, with chloride of lime 


solution (six ounces to the gallon of water). 


THE DISINFECTION OF A ROOM IN WHICH AN 
INFECTIOUS DISEASE HAS EXISTED. 


The room having been abandoned, the door 
should be locked and no one permitted to 
enter for twelve to twenty-four hours, during 
which time the particles of dust and any in- 
fectious agent suspended in the atmosphere 
are given time ‘to settle The Jiberation: of 
steam in the room somewhat hastens the pro- 
cess. The persons engaged in the disinfection 
of the room should wear clothes such as are 
described on page 11, in addition to which 
Fliigge suggests the use of sponge respirators 


IN RELATION TO INFECTIOUS DISEASES 4) 


——— 








They should be provided with sheets and bags 
of various sizes moistened with sublimate 
solution, together with metal buckets, sponges, 
scrubbing-brushes, mops, coarse towels, etc., 
in a galvanized box, together with plenty of 
disinfectant solution, soap, sal-soda, and _ hot- 
water. 

On entering the room the pieces of furniture 
are covered with the sheets and various arti- 
cles are placed in the bags. The floor, window- 
sills, and all surfaces on which dust may have 
lodged should now be mopped up, or wiped 
with coarse towels moistened with hot disin- 
fectant, and wrung out at frequent intervals in 
a bucket containing the solution (5 per cent. 
of carbolic acid or 1 to 1,000 sublimate). 
Valueless articles should, if practicable, be 
burnt in the room. 

The walls of the room can now be sponged off 
with disinfectant, or be rubbed down with glu- 
tinous brown bread, or finally, after being dis- 


48 HYGIENIC MEASURES 





infected or scraped, be whitewashed. If bread 
is used the crumbs that fall can be caught, to 
a large extent, on newspapers placed on the 
floor, and these, together with the crumbs, 
burnt. One has to guard, as much as possible, 
against particles of bread adhering to the walls, 
and, as an extra precaution, it would for this 
reason be well to wipe the walls, after the first 
application of bread, with a sponge dampened 
with the disinfectant, and after the walls had 
dried use fresh bread a second time. The 
cleaning of the walls to a height of six feet is 
usually recommended. The writer believes it 
would be safer to disinfect the whole surface 
of the walls. Rooms with papered walls 
should not be repapered without being disin- 
fected. The furniture and objects which have 
been placed in the moistened sheets and bags 
can now be removed from their wrappings and 
disinfected. 

The furniture is brought piece by piece to 


IN RELATION. T0..INFECTIOUS DISEASES. 49 





the centre of the room and the sheet removed. 
Upholstered articles should be wiped off with 
sublimate solution (1 to 1,000) on a.moistened 
sponge, which should be wrung out frequently 
in the bucket. The articles should be then 
put in a place where they can dry rapidly. 
Polished furniture can be wiped off with a 
sponge, moistened with the same disinfectant. 
The floors, bedsteads, chests of drawers, win- 
dows, doors, fireplaces, wooden mattress 
frames, etc., should be scrubbed or wiped off 
with hot disinfectant solution, followed by 
plenty of scrubbing with soap, sal-soda (espe- 
cially when sublimate has been employed), and 
hot water. In fact, it is best to trust to the 
thorough use of this simple agent (hot water 
combined with soap) than to place confidence 
in badly applied chemical disinfectants. The 
means of disinfection which should be applied 
to clothing, linen, bedding, etc., are considered 
on page 38. The slops, as already mentioned, 
4 


fo hal 


50 HYGIENIC MEASURES 








should be disinfected before being thrown into 
the drains. In the country care should be 
taken that they do not in any way contaminate 
the water supply. 


THE DISINFECTION OF SHIPS. 
Satisfactory disinfection of ships is scarcely 
possible, but a good deal can be accomplished 
by observing certain precautions. Vessels ply- 
ing between ports where infectious diseases, 


- such as cholera or yellow fever, occur should 


be well ventilated throughout and dispense as 
much as possible with curtains, woollen and 
upholstered articles, etc., during the prevalence 
of the disease. They should be kept scrupu- 
lously clean, the closets disinfected, and the 
bilge pumped out and cleansed at sea before 
entering the harbor on the return from an in- 
fected port. The pumps should always be 
accessible for this purpose. As far as possible 
the crews of vessels trading in tropical ports 
should be acclimatized. In ports infected with 
yellow fever, vessels should be anchored, when 


IN RELATION TO INFECTIOUS DISEASES, 51 





possible, in the harbor and the crew prohibited 
from going ashore, especially at night. Ves- 
sels should be disinfected by being washed 
down thoroughly in every accessible place, 
more particularly in those occupied by the 
sick, by means of a solution of sublimate or 
carbolic acid applied in the strength and 
manner described on page 16. The burning 
of sulphur followed by the use of soap and 
hot water has been recommended in addition 
to the above measures. (Amerzcan Public 
Health Association Report, 1888.) 


+ 


THE DISINFECTION OF RAILWAY CARS, 


The rules laid down for the disinfection of 
rooms, etc., apply here also. During the 
prevalence of cholera, excreta should most 
certainly not be scattered along the track 
without being disinfected (page 57). 


DISINFECTION OF MAILS AND MERCHANDISE. 


This is very rarely necessary, and to carry 
out proper disinfection is scarcely possible in 


52 HYGIENIC MEASUKES. 





practice, on account of the bulk of the objects 
and the injury to which they are liable. Fumi- 
gation by means of sulphur is practised and 
recommended for this purpose, but as usually 
applied is useless (page 22), whilst we have no 
right whatever to rely on “free aération” as a 
means of disinfection (page 25). Reliable 
means for the disinfection of various articles 
are given elsewhere in this book. 


PYRORMATION: AS: TOMPHE CAUSE-AND 
MeO rGOU SPREADING OR (CERTAIN IN- 
Pen GS DIS RAS KE SrA N Dam Erbe P Ril 
VENTIVE MEASURES THAT SHOULD 
peer eoOktD CO, ISORA TION, DISIN- 
BmEGllON aE Te. 

In the following pages those diseases in 
connection with which it is necessary to carry 
out a complete system of disinfection are in- 
dicated by having their names printed in large 
type. Immediately beneath the name of each 
disease will be found that of the parasite 
which causes it. The letters “O. P.” (mean- 
Pion ODiicatory= parasite’ ) and 9? P. o Ps 
(meaning “facultative parasite”) placed after 
the name of the pathogenic organism indicate 
whether the latter is capable of multiplying 
outside the body (of leading a saprophytic 
existence under natural conditions), or is only 
able to live parasitically. 

23 


> 


54 HYGIENIC MEASURES 


Under three headings will be found the 
following information : 

1. How the infection spreads. How long 
the infectious material may remain virulent. 
Its resistance to heat, chemical disinfection, 
etc. The conditions which favor the develop- 
ment and maintenance of virulence of the 
infectious agent. 

2. Measures which must be taken to prevent 
the spread of the disease, such as isolation, etc. 

3. The disinfection which should be pursued. 

The information is sadly incomplete insome 
cases, owing to our ignorance of the nature 
of the specific agent which causes the disease, 
or its mode of attacking the body. 


1.—Actinomycosis (“ Big-jaw”’ of Cattle). 
CAUSE: ACTINOMYCES OR “ RAY-FUNGUS.” 
Mode of Infection, ete. 
As the pus in this affection, and cultures of actinomy- 


ces derived therefrom, have been shown to be infectious 


by inoculations in animals, the pus should be treated as 


IN RELATION £0 INFECTIOUS DISEASES. 55 





infectious matter. The specific agent probably enters 
the system with the food, from the fact that the site of 
infection is usually, both in man and animals, the mouth 


or passages leading therefrom. 


Preventive Measures and Disinfection. 


Pus or anything soiled therewith should be disinfected 
(page 38). 


2.—Anthrax (Malignant Pustule). 


CAUSE : BACILLUS ANTHRACIS, F. P. 


Mode of Infection, ete. 


The disease, which is epidemic amongst cattle and 
sheep, is most frequently communicated to men engaged 
in scraping horns, skinning carcasses, or wool-sorting 
(wool-sorter’s disease), the hands, less frequently the 
face and neck, in short the exposed parts of the body, 
usually being the seat of inoculations through abrasions 
and cuts. The bacilli are present in the blood and 
cedematous fluid of man and animals when the disease 
is general. When the disease is local (“malignant pus- 
tule ’’) as is usually the case in man, the bacilli are present 
in the secretion from the pustules. The feces, and bloody 


urine of sheep and cattle may contaminate the surface 


56 HYGIENIC MEASURES 








soil and vegetation of pastures. Insects feeding on 
excreta or cadavers of anthracic animals will spread 
the disease by bites inflicted on other animals or 
possibly man. All bandages which have been in con- 
tact with the pustules are dangerous. The disease may 
also occur through eating the smoked flesh of anthracic 
animals, where, owing to the bacilli having taken on the 
spore form, they may retain their virulence indefinitely. 
This form of the disease (internal anthrax) may also be 
brought about, as it has been experimentally, by the in- 
halation of spores. The fresh secretions, blood, etc., 
only contain the bacilli in the vegetative stage, when 
they are readily killed by carbolic acid or boiling water, 
though they withstand drying for several days. The 
bacilli in spilled blood, etc., form very resistant spores, 
which remain virulent for years in a dry state. They 
resist five per cent. carbolic acid as long as thirty-seven 
days,.and corrosive sublimate, 1 to 1,000, for twenty-four 
hours, Moist heat at 100° C, (212° F.) applied for four 


minutes kills the spores. 


Preventive Measures. 


Infectious skins should be destroyed and anthracic 
animals buried in deep pits, their bodies being covered 
with chloride of lime. Protective inoculations (Pasteur) 


WVERELALLON TO INFECTIOUS DISEASES. 57 





have been applied with a view of limiting the disease in 
animals. Bandages, infected clothing, or dressings soiled 
by the discharges of malignant pustules should be very 
carefully handled and disinfected. 


Disinfection. 
‘Soiled dressings, bandages, etc., should be burnt; 
other articles, when practicable, should be boiled or 


sterilized by steam for at least fifteen minutes. 


3.—Cholera. 


CAUSE : SPIRILLUM CHOLER ASIATICA,  F. P. 
Mode of Infection, etc. 


The infection occurs through the fresh dejections, 
very exceptionally through the vomit, of cholera patients, 
conveyed more or less directly in water or food to the 
digestive tract of another individual. The water supply 
may be contaminated by discharges, through the wash- 
ing of soiled linen, or surface drainage. Insects may 
contaminate food. The food may be also contaminated 
through the soiled hands of attendants or sick persons. 
The spirilla will multiply readily if they gain access to 
milk, bouillon, meat, etc. 

If dried the spirilla soon lose their virulence, so that 


infection probably never occurs through the air becom- 


58 HYGIENIC MEASURES. 








ing a vehicle forthe disease agent. Culture experiments 
show the spirilla to die in two or three hours if dried in 
a thin layer, whilst in thicker layers they may live for 
twenty-four hours. At a low temperature combined 
with incomplete drying the spirilla may remain alive for 
weeks or months. Freezing has no effect on the organ- 
isms. In water at 60° C, they are killed off in ten 
minutes. They are very sensitive to disinfectants, and 
die in putrefying fluids in about two weeks. One 
half per cent. carbolic acid kills them in a few minutes. 
Acquired immunity is of short duration—that is, it can 
only be relied on to protect individuals (with very few ex- 


ceptions) from a second attack during the one epidemic. 


Preventive Measures. 


What has been said for typhoid fever (page go) applies 
to cholera also. The necessity of keeping the sick- 
room well ventilated, so as to kill the spirilla by the 
simple process of drying, 1s apparent. Soiled linen 
should not be allowed to stay in cool, dark, and damp 
places, or be transported in a damp state, and should be 
disinfected and hung up in the sun to dry and air. The 
fact that washer-women are particularly prone to con- 
tract the disease is a direct indication that the handling 


of soiled linen, etc., is dangerous. 


IN RELATION TO INFECTIOUS DISEASES. 59 


During epidemics the preventive measures referred to 
in the case of typhoid apply here also. Extra care 


should be taken about the cooking of the various foods. 


Disinfection. 


Proceed as in typhoid fever (page gz), 


4.—Diphtheria. 
CAUSE ; ‘BACILLUS DIPHTHERIA. Or DP: 


Mode of Infection, ete. 


The infection is spread through the bacilli in the sputa, 
false membrane, and secretions of the various diseased 
mucous membranes. The bacilli are probably present 
at times in the stools. Physicians and nurses are partic- 
ularly exposed to the danger of the infection when swab- 
bing the throats of patients, through the coughing of 
mucus and flakes of membrane into their faces. Lesions 
of the mucous membranes where no susceptibility exists 
predispose to infection. The diphtheria of pigeons, 
calves, pigs (not determined in the case of the cat) is 
not to be feared as a source of human diphtheria, the 
diseases being due to different specific agents. 

As the bacilli resist drying they may be scattered 
about in the form of dust, In thin layers the bacilli 


60 HYGIENIC MEASURES 


—_———« 





withstand drying for fourteen days, whilst in pieces of 
membrane, clothing, particularly when in dark, damp, 
and cool places, they may retain their virulence for four 
to seven months. A temperature of-58° ©. (736° #2 
kills them in ten minutes. They apparently die in a 
few days in putrefying substances. The bacilli multiply 
at 18° C. (64° F.), and milk being an excellent medium 
for their growth, the milk of: dairies in a vicinity where 
the disease prevails may be a carrier of the infection and 


promote the development of the infectious organism. 


Preventive Measures. 


Complete isolation of the patient is necessary as long 
as the slightest trace of the membrane is present, and for 
some time after it disappears.. Children should be kept 
from attending school at. least four weeks after the 
disease has disappeared, Where the disease prevails, 
Loeffler maintains the importance of keeping the mouths, 
noses, and throats of healthy children clean, using for 
this purpose an aromatic or other wash, every three or 
four hours ; sublimate, 1 to 10,000 or 15,000; cyanide 
of mercury 1 to 10,000,; chloroform water, etc. For the 
patients he recommends a gargle every two to three 
hours of the nature recommended above, together with 


a stronger one used at longer intervals; namely, subli- 


IN RELATION TO INFECTIOUS DISEASES. O61 


mate r to 1,000; three per cent. carbolic acid in thirty 
per cent. alcohol ; or equal parts turpentine and alcohol 
containing two percent. carbolic acid. These washes 
are intended to prevent the settlement and development 
of the bacilli on adjacent mucous membranes, and limit 
the growth of the membrane. Virulent bacilli could not 
be found after a few days when this treatment was fol- 
lowed, whereas they are to be found usually after three 
weeks when the ordinary treatment is pursued. Special 
precautions should.be taken when using poisonous solu- 


tions in the treatment of children. 


Disinfeetzon. 


See “ Practical Directions,” page 27. 


s.—Dysentery (Ameebic Dysentery). 


CAUSE : AMCEBA DYSENTERI. 


Mode of Infection, ete. 


The dejections of the patients contain the amcebe in 
such enormous quantities, and the latter bears such an 
unquestionable relation to the disease, that the stools 
should be treated as infectious material and the possible 


contamination of the water supply guarded against. 


62 HVGIENIC MEASURES 





Preventive Measures. 


The precautions noted in the case of typhoid fever 
and cholera as regards the treatment and handling of 
stools, soiled linen, and the person of the patient, apply 
here also. 

Disinfection. 

Disinfection to be pursued as in typhoid fever (page 

Q2). 
6.—Erysipelas. 


CAUSES STREP LOCOECECUS ERYSIPELATOS. 
Mode of Infection, ete. 


Occurs usually as epidemics in hospitals. It is rarely 
found as an epidemic otherwise. The disease is easily 
communicated from one person to another. The strep- 
tococcus erysipelatos, resisting dryness, can float in the 
air as dust and reach wounded or abraded surfaces in a 
variety of ways. It is killed by moist heat at 54° C. 


(129° F.) in ten minutes (Sternberg). 


Preventive Measures. 


Prompt isolation of cases of erysipelas in hospitals is 
necessary, and it the disease continues to appear in the 


wards empty the latter, thoroughly disinfect them and 


IN RELATION TO INFECTIOUS DISEASES. 63 








all the furniture they contain. The clothing and bed- 
ding of the patients should be sterilized before their re- 
turn to the wards. Physicians and nurses should disin- 
fect themselves, their clothing, etc. Carelessness or some 
oversight will be found invariably connected with the 


spread of this disease. 
Disinfection. 


All dressings, bandages, etc., should be burnt, and 
other objects disinfected by boiling or chemical disin- 


fectants (see ‘“ Practical Directions ”’). 


7.—Glanders or Farcy. 


CAUSE: BACILLUS MALLEI. 0. P. 
Mode of Infection, etc. 


The disease can be transmitted to man directly from 
diseased domestic animals [the horse, donkey (sheep, 
young dogs, and cats are also susceptible experimen- 
tally)] through the fresh secretions or excretions of the 
mucous membranes and skin, which may adhere to 
various articles about and produce the disease by in- 
oculation through a cut or an abraded surface of the 
skin or on the mucous membrane. The bacilli lose 


their virulence in a few days when dried, though they 


64 HYGIENIC MEASURES 











have been found to resist putrefaction for twenty-four 
days. They are killed after ten minutes at 55° C. (131° 
F.). Three to five per cent. carbolic acid or scalding 


water readily renders them harmless. 


Preventive M. CASUTES.' 


Isolation of the patient is imperative. Horses suffer- 
ing from glanders should be killed and buried in a grave 
eight feet deep. To facilitate this, cutting off the legs 
of the animals is advisable. Chloride of lime should be 
thrown over the body before heaping on the earth. 
Bridles, bits, pails, and troughs should be disinfected. 


Disinfection. 


Where glanders has existed in a stable remove every- 
thing that is portable, burning as much as is practicable. 
Loose pieces of boarding, etc., especially the woodwork 
about the manger, should be destroyed in this way. 
Wash and clean out the stall thoroughly and then scrape 
it. Rinse it out with cold water, being sure at the same 
time to scrape out all cracks in the floor and woodwork 


with a sharp instrument, following this with the applica- 


1 For particulars in relation to the treatment of diseased horses 
and stables, the writer is indebted to A. W. Clement, V. S., of 
Baltimore. 


IN RELATION TO: INFECTIOUS DISEASES, . 65 





tion of scalding water wherever practicable, and fifty 
per cent. permanganate of potash solution. Finally, 
apply whitewash and scatter fresh chloride of lime on 
the floor. 


$.—Gonorrhea. 


CAUSE: MICROCOCCUS GONORRHE, O. P. 


Mode of Infection, etc. 


Through fresh secretions coming in contact with 
mucous membranes of the urethra or conjunctiva. The 
gonococcus is killed by an exposure to moist heat at 60° 


C. (140° F.) for ten minutes (Sternberg). 
Preventive Measures. 


Persons suffering from this disease should be careful 
that no other person touch clothes, towels, or handker- 
chiefs soiled by gonorrheeal secretions. They should also 
guard themselves against gonorrhceal ophthalmia by dis- 
infecting their hands, etc., when the latter have come in 


contact with the urethral discharge. 
Disinfection. 
Rags and scraps. of linen soiled by secretions should be 
burnt ; towels, etc., boiled or soaked in corrosive sub- 


limate solution (1: 1,000) to which five parts sodium 


chloride have been added. 
5 


66 HYGIENIC MEASURES 


9.—Hydrophobia—Rabies. 
CAUSE : UNKNOWN. 


Mode of Infection. 


Through the bites of rabid animals and their fresh 
saliva (experimentally produced by inoculation with their 
brain and spinal cord). The virus loses its pathogenic 
qualities after an exposure to moist heat at 60° C. (140° ° 


F.) for ten minutes. (Sternberg.) 


Preventive Measures. 


Very effectual laws exist regarding this disease in Ger- 
many. No dogs are allowed on the streets during the 
prevalence of rabies without being muzzled and led. 


Unmuzzled dogs are promptly killed. 


10.—Influenza. 


CAUSE : BACILLUS OF INFLUENZA, 


Mode of Infection, ete. 


Infection doubtless occurs from individual to in- 
dividual, and more or less indirectly. On account of 
the large number of organisms in the sputa, Leeffler 


suggests that these be treated as infectious material. 











IN RELATION TO INFECTIOUS DISEASES. 67 


Preventive Measures. 


During epidemics of influenza those persons who are 
especially liable to succumb (old persons or those suffer- 
ing from heart disease, etc.) should absent themselves 
from public assemblages (where they expose themselves 
to a confined atmosphere contaminated by the presence 
of the infectious agent) and more or less completely 
isolate themselves. 


Disinfection. 


Sputa should be disinfected. 


1z1.—Leprosy. 
CAUSE ;: BACILLUS LEPRA, O. P. 


Mode of Infection, etc. 


That leprosy is contagious is doubted by many. 
We consider it a reasonable supposition that the con- 
tagiousness of the disease is obscured by the fact that 
the majority of. individuals are resistant and that the 
disease develops very slowly. Where the disease has 
been ascribed to contagion usually the most intimate 


sexual relations with diseased individuals have existed. 


68 HYGIENIC MEASURES 


Preventive Measures. 


Isolation of patients in leper hospitals in various parts 
of the world has reduced the amount of the disease. 
Inter-marriage of leprous individuals should not be 
permitted. 

Disinfection. 


Dressings should be burnt. 


12.—Malaria. 


CAUSE : PLASMODIUM MALARIA, 


Mode of Lnfection, etc. 


This disease is not contagious. We do not know 
how invasion occurs. It is acquired most readily in 
low, marshy or badly drained regions, where abundant 
vegetable growth occurs, such conditions being found 
especially in tropical and sub-tropical regions. The dis- 
ease in temperate climates prevails most in autumn, 
especially after hot dry summers, and in the tropics dur- 
ing the rainy season. Facts are on record which point to 


the wind as a carrier of the poison. 


Preventive Measures. 


From the fact that infection seems to occur most 


frequently at night, persons should avoid exposure at that 


IN RELATION TO INFECTIOUS DISEASES. 69 


time. It has been repeatedly shown that persons occupy- 
ing the upper stories of a house do not acquire the disease 
as do those living nearer the ground. ‘Trees planted in 
malarial districts have been considered to have a preven- 
tive influence. Where the disease prevails extensively 
Osler recommends the boiling of drinking water. In 
highly malarious districts ten grains of quinine should be 
taken daily ; smaller doses, three to five grains, will other- 
wise suffice, and Jones recommends the use of this remedy 
until ten days after exposure. - The severity of attacks is 
moderated when not prevented by the use of this remedy. 


13.—Malignant C:dema. 


CAUSE : BACILLUS (DEMATIS MALIGNI., F. P. 


Mode of Infection, etc. 


The specific organism is frequently found in the 
surface soil, especially at times in garden-earth and in 
putrefying matter. The dust of apartments, hay-lofts, 
and that derived from rags, also the intestinal con- 
tents of animals, have been found to contain them. They 
are found at times together with the tetanus bacilli, pro- 
ducing infection under the same conditions. Pieces of 
muscle of an animal dead of the disease have been found 


to contain virulent bacilli after one year. 


70 HYGIENIC MEASURES 


—— 











Preventive Measures and Disinfection. 


Proceed as in tetanus (p. 83). 


14.—Measles. 


CAUSE : UNKNOWN. 


Mode of Infection. 
The infection is spread through the products of ‘the 


diseased skin and mucous membrane, especially the nasal 
secretions. ‘The infectious agent may remain virulent for 


six weeks, One attack does not always confer immunity. 


Preventive Measures and Disinfection. 


This disease is infectious in the first degree (see table, 
p- 29), and in consequence the precautions laid down 
under “ Practical Directions” apply here in a general 
way. 

15.—Cerebro-Spinal Meningitis. 


CAUSE: THE DIPLOCOCCUS PNEUMONIZ HAS BEEN 
ISOLATED FROM THE CEREBRO-SPINAL FLUID. 


Mode of Infectzon, ete. 


Not directly contagious, probably not transmitted by 
clothing or excreta; occurs sporadically and as an 


epidemic (Osler). 


VO RELATION TO'\INFECTIOUS DISEASES. 71 


Preventive Measures. 


Good ventilation and isolation are indicated, from the 
fact that crowding of individuals in barracks or tenement- 


houses offers favorable conditions for the development 
of epidemics of the disease. 


16.—Mumps (Epidemic Parotitis). 
CAUSE : UNKNOWN. 


Mode of Infection, ete. 


A contagious, often epidemic, disease most frequently 


attacking children and adolescents. One attack immuni- 


fies. We lack definite knowledge as to the mode of 
. infection. 


Preventive Measures. 
Isolation. 


17.—Pertussis (Whooping-Cough). 
CAUSE: UNKNOWN. 


Mode of Infection, ete. 


A contagious disease, the gravity of which is fre- 
quently not sufficiently appreciated by parents, 


A great 
deal of neglect exists in this respect, 


72 HYGIENIC MEASURES 


Preventive Measures. 


Children suffering from this disease should be promptly 
isolated and prevented from attending schools. 


18.—Pneumonia. 


CAUSE : DIPLOCOCCUS PNEUMONIA, 
Mode of Infection, ete. 


The contagiousness of this disease is unproven, 
though probable at times (epidemics in barracks, etc.). 
For the reason that only a limited number of individuals 
are susceptible, that the organisms vary greatly in 
virulence, and that a certain number of individuals (15 
to 30 per cent.) have the specific organisms of pneumonia 
normally present in the mouth, in such cases the disease 
might well arise at any time under favorable conditions 
and it would not be preventable, but from the fact that 
the sputa of pheumonic patients contain large quantities 
of the pneumococcus they should be treated as infectious 
matter. The pneumococcus withstands drying and re- 
mains infectious for two or three months in diffuse light 
at room-temperature, and consequently could very well be 
inhaled as dust and reproduce the disease under proper 
conditions, | 


PV EAELATION TOUNFECTIOUS DISEASES.473 


Preventive Measures. 


In the case of house epidemics, isolation and free 
ventilation are indicated, as also a thorough cleansing of 
apartments. , 


Disinfection. 


Disinfect sputa by boiling or burning. 


19.—Puerperal Fever. 


CAUSE: VARIOUS PYOGENIC BACTERIA (STAPHYLOCOCCI 
AND STREPTOCOCCI). 


Mode of Infection, ete. 


Pathogenic micro-organisms are invariably present in 
this disease. Though auto-infection may occur, in the vast 
majority of cases the disease is spread through the agency 
of physicians, midwives, or nurses, especially is this so 
in epidemics, where the hands, instruments, etc., of those 
in attendance are not properly disinfected. The patho- 
genic organisms find a very good opportunity for their 
multiplication in the presence of the broken-down tissue 
and the wounds which occur in the genital tract during 
parturition. As the organisms which produce this dis- 
ease are capable of resisting desiccation they can be 


suspended in the form of dust, thus contaminating the 


74 HYGIENIC MEASURES 


atmosphere of the room or ward. (Regarding the degree 
of resistance exhibited by the infectious agent see figures 
in connection with pyogenic bacteria, page 79.) 


Preventive Measures. 


The first duty of the physician should be to avoid 
attending cases of labor when fresh from the presence 
of erysipelas, puerperal fever, scarlatina, or other 
infectious diseases or septic material. Frequent ex- 
amination during labor should be avoided. In hos- 
pitals women before admission to the obstetrical wards 
should, if possible, be well bathed and clothed in fresh 
linen. The external genitalia and surrounding parts 
should be well washed with soap and water, followed by 
sublimate 1 to 2,000, with which the vagina should be 
carefully irrigated both before and after labor. Com- 
presses moistened with dilute disinfectants are also 
recommended as applications to the external genitalia 
during the progress of labor. 

Patients should be isolated promptly on the first ap- 
pearance of any suspicious symptoms, and a special nurse 
put in charge of the case. Physicians should take the 
precautions regarding the disinfection of instruments, 
hands, etc., which are noted on page 96. These ob- 
servations apply also to midwives and nurses, When 


IN RELATION TO INFECTIOUS DISEASES. 75 


the disease prevails in hospital wards take the precautions 


observed in relation to erysipelas under like conditions, 
Disinfection. 


As in erysipelas—see above. 


20.—Relapsing Fever (Febris Recurrens). 


CAUSE : SPIRILLUM OBERMEIERI. 
Mode of Infection, etc. 


A moderately contagious, at times epidemic, disease, 
portable (according to Murchison) by fomites. The 
disease has been reproduced by inoculations in man and 
monkeys made with the blood of individuals suffering 
from the disease. The life history of the specific agent 
is unknown. Neither age nor season have any particular 
influence. One attack does not protect either in the 
experimentally or naturally acquired disease, Over- 
crowding, such as occurs in tenement-houses, and lack of 
food (hence also called “ famine fever”’ or “ hunger pest,” 


etc.) promoce the spread of the disease. 
Preventive Measures. 


Good ventilation and food are directly indicated, as 


the absence of these promotes the spread of the disease. 


76 HYGIENIC MEASURES 


The disease is not likely to spread from a single case 
placed in a well-ventilated apartment. Persons suffering 
from this disease in tenement-houses should be removed 
to hospitals, and the population of overcrowded tenements 
thinned (Osler, Flint, etc.). 


21.—Rubella; Rotheln. 
CAUSE: UNKNOWN. 


Mode of Infection, ete. 


Spreads with great rapidity, and often extensive epi- 
demics occur ; readily communicated from one individual 
to another. (The occurrence of either measles or scar- 
latina in childhood does not afford protection against it.) 
(Osler.) 


Preventive Measures and Disinfection. 


See measles, page 70. 


22.—Scarlatina. 
CAUSE: UNKNOWN. 


Mode of Infection, etc. 


Scarlatina is spread after the same manner as small- 


pox. The infectious agent may remain virulent for five 


IN RELATION TO INFECTIOUS DISEASES. 77 


months, and possibly longer at times. Unless an attack 
has been mild, immunity is usually afforded for a number 
of years. The contagiousness probably begins with des- 
quamation. According to Henry, scarlatinal virus loses 
its virulence after being exposed to dry heat at 100° C, 
(212° F.) for one hour. 


Preventive Measures. 


The same precautions regarding isolation should be 
practised as in the case of smallpox. Desquamation 
lasts from ten to fifteen or twenty days, and may continue 
at times for weeks. Oiling the skin every day or second 
day, combined with soaking in hot baths during desqua- 
mation, and washing with carbolic soap, are recommended. 
The feet being very slow to desquamate, the process can 
be hastened by hot foot-baths with soda, combined with 
rubbing with pumice-stone. Socks and gloves smeared 
with ointment (carbolic or salicylic) should be used. 
Probably when desquamation has lasted four weeks and 
daily baths have been resorted to in the way above men- 
tioned, the person can be dismissed. Convalescent hos- 
pitals for the reception of scarlatinal patients are specially 
recommended. 


Disinfection. 
See smallpox, page 78. 


78 HYGIENIC MEASURES 


23.—Smallpox. 
CAUSE : UNKNOWN. 


Mode of Infection, ete. 


The infection is spread through the products of the 
diseased skin and mucous membrane (the sputa, nasal 
secretions, etc.). It is not known whether the contagion 
occurs prior to the desquamative stage. The disease 
agents are apparently given off in enormous quantities, 
and as they withstand drying they may tenaciously adhere 
to anything about the patient, thus infecting objects and 
persons around him. The light epidermal scales derived 
from the patient may float in the air as dust, and doubt- 
less are capable of producing the infection through inha- 
lation. With very few exceptions one attack immunifies 
for ife or for years. The infectious agent may remain 
virulent for two years, and in certain cases it has been 
shown to last even longer. This will vary according to 


the conditions under which the infectious agent is placed. 


Preventive Measures. 


Prompt isolation is imperative. Special hospitals, to 
which the patient should be promptly transferred, should 
be provided. No public conveyances should be used 


for the transportation of the sick to the hospital. 


IN RELATION TO INFECTIOUS DISEASES. ‘79 


The patient should be kept scrupulously clean, the body 
linen, etc., being often changed. Disinfectant washes 
should be used for the discharges from the mouth, nose, 
and eyes. Lint moistened with dilute disinfectant solu- 
tions can be applied to the skin, and when crusts form, 
carbolized oil, glycerin, or vaseline should be used to 
keep the epidermal scales from being scattered as dust’ 
Isolation should be continued until the skin is perfectly 
normal (free from any trace of scabs). 
Drsinfection. 

The precautions and methods of disinfection and 

isolation laid down in broad lines under the head of 


’ 


“Practical Directions ”’ apply here. 


-24.—Suppuration, Septicemia, and Pyxzmia. 


CAUSE: VARIOUS’ BACTERIA, THE MOST VIRULENT OF 
WHICH ARE THE PYOGENIC STREPTOCOCCI. THE 
FOLLOWING ORGANISMS MAY BE FOUND: STAPHYLO- 
COCCUS PYOGENES AUREUS, ALBUS, CITREUS, EPIDER- 
MIDIS ALBUS, STREPTOCOCCUS PYOGENES, MICRO- 
COCCUS TETRAGENUS, BACILLUS PYOCYANEUS, 
BACILLUS FTIDUS, ETC. 


Mode of L[nfection, etc. 


The infection may be spread through the fresh or dried 
secretions from infected wounds, which may adhere to all 


80 HYGIENIC MEASURES 


kinds of objects about the patient—to instruments, hands 
of attendants, etc. Insects may act as carriers. Patho- 
genic bacteria are frequent on the body of healthy indi- 
viduals and in the skin (staphylococcus epidermidis albus). 
They vary greatly in virulence, and the susceptibility of 
the patient varies also. Fresh secretions containing strep- 
tococci are most virulent. Secretions of abscesses, 
furuncles, phlegmons, empyema, osteo-myelitis, pyzemia, 
and progressive gangrene should be treated as infectious 
material. The pathogenic cocci may remain alive in a dry 
or moist state for one year or longer. As they withstand 
drying, they may float in the air as dust and gain access to 
wounds in a variety of ways. According to Sternberg, 
staphylococcus pyogenes aureus, citreus, and albus, and the 
bacillus pyocyaneus are killed by an exposure to moist 


heat at a temperature of 62° C. (143° F.) for ten minutes. 
Preventive Measures. 


Modern surgical technique has demonstrated the value 
of antisepsis so fully that it seems superfluous to enter 
upon the subject here. The disinfection to be carried 
out in the operating-room will be found on page 96. All 
bandages and objects which have become contaminated 
should be disinfected promptly. Patients suffering from 


septiczemia or pyzemia should be isolated. 


IN RELATION TO INFECTIOUS DISEASES, 8t 





Disinfection. 


All wound dressings and bandages should be burnt, 
and other contaminated objects disinfected as noted in 
the text. 


25.—Syphilis. 
CAUSE : UNKNOWN. 


Mode of Infection, ete. 


Through various secretions coming in contact with 
abraded mucous membranes or skin. It is not known 
how long the infectious agent may remain virulent, but it 
is generally stated that the secretions must be fresh. As 
a rule acquired by coitus. Fournier and Ricord consider 
that about 25 per cent. of all cases of syphilis occurring 
in females, lessso in males, are innocently or non-venere- 
ally acquired, and this in a variety of ways, as shown by 
reported cases (Bulkley). It does not seem out of place 
to mention some of these: (1) transmission in domestic 
life from articles used by syphilitic subjects, such as 
spoons, knives, forks, cups, glasses, tobacco-pipes, cigars ; 
wearing apparel, such as shirts, drawers, bathing-suits, 
and handkerchiefs ; from bedding and toilet articles, such 
as sponges, combs, tooth-brushes, syringes, pins, etc. ; (2) 


personal transmission, most frequently by kissing, also oc- 


82 HYGIENIC MEASURES - 








casionally by biting and scratching ; (3) in infants, besides 
being directly transmissible to the nurse or the infant, milk- 
bottles, sugar-teats, spoons, cups, etc., have been known 
to convey the disease ; (4) transmission may also occur in 
attendance on the sick ; either the physician or midwife 
may acquire the disease in the practice of their professions 
by contact with specific sores on various parts of the 
body, or the reverse,—that is, they may convey the disease 
directly or indirectly by instruments (many cases recorded 
in relation to the use of the Eustachian sound), specula, 
etc. Vaccination, tattooing, and ritual circumcision, as 
well as the removal of foreign bodies from the eye with 
the tongue, have been the means of communicating the 
disease. To repeat, all the modes of transmission already 
mentioned have been known to occur in well authenticated 
cases, 


Preventive Measures. 


Strict medical supervision of prostitution materially 
reduces the amount of syphilis, as has been strikingly 
demonstrated in barrack-towns. Sentimental ideas should 
not blind but open the eyes of the public to the necessity 
of regulations which will protect a large number of inno- 
cent persons who fall victims to the disease through the 
agency of those that have transgressed. 


IN RELATION TO INFECTIOUS DISEASES. 83 


——— 





Regarding marriage in relation to this disease, the 
cc“ 


physician “should insist upon the necessity of two full 
years elapsing between the date of infection and the con- 
tracting of marriage. This, it should be borne in mind, is 
the earliest possible limit, and there should be at least a 
year of complete immunity from all manifestations of the 
disease ”’ (Osler). 

What has been said in the preceding column will 
plainly enough suggest other precautions, which consci- 


entious individuals will at any rate attempt to observe. 
Disinfection. 


Burning, boiling, or chemical disinfection of any 
objects or dressings which have come in contact with in- 


fectious secretions. 


26.—Tetanus (Lock-Jaw). 
CAUSE: BACILLUS) TETANI, Fo P. 


Mode of Infection, ete. 


The spores of the tetanus bacillus are very generally 
distributed in the surface soil, and have been isolated 
also from the dust of streets and apartments, and 
from putrefying fluids and feces. Soils from certain 


localities are particularly virulent. The wound secretions 


84 HYGIENIC MEASURES 








from a tetanic man or animal, and everything that has 
come in contact therewith, are dangerous if the virus is 
introduced subcutaneously. Wooden splinters or earth 
getting especially into deep lacerated wounds are most 
_frequently carriers of the infectious agent, which, more- 
over, has apparently to enter the body in a certain 
Gienin to produce the disease. 

The bacilli, both in culture and in dried secretions, as- 
sume the spore stage, in which they withstand drying for 
along time. In some cases they have been found virulent 
after six months, and even after more than two years, 
The spores withstand dry heat at 150° C. (302° F.) for 
ten minutes, but are all killed off inside of eight minutes 
by moist heat at 100° C, (212° F.). 


Preventive Measures. 


Guard against the handling of bandages, etc., soiled by 
wound secretions, Tetanus in new-born children is 
usually due to infection through the navel and should be 
guarded against by antiseptic dressings of the latter, 
etc. Anything that may have become contaminated by 
wound secretions of a tetanic subject, including bedding, 
etc., should be carefully handled and disinfected. The 
necessity of prompt washing of wounds where dirt has 
entered as well as the removal of splinters, etc., and the 


UN RELATION “TO INFECTIOUS DISEASES. 85 





non-use of dirty rags, cobwebs, etc., on cuts should be 
brought home to the public. 


Disinfection. 


Dressings, etc., should be treated as in anthrax (p. 57). 


27.—Trichiniasis. 
CAUSE: TRICHINA SPIRALIS. 


Mode of Infection, etc. 


Infection occurs in man through the ingestion of im- 
properly cooked pork containing encapsuled embryos. 
The capsules are dissolved in the alimentary canal 
and the trichinz liberated. In about three days after 
ingestion the embryo reaches maturity, and in about 
a week produces hundreds of fully developed embryos, 
which pass through the intestines and reach the muscles, 
become encapsulated therein, and their development 
ceases. Through the process of calcification, which lasts 
four to five months in man, and at times years in the 
hog, the opaque, oat-shaped cysts become visible to the 
eye. Trichinz have been known to develop after lying 
twenty-four years encapsuled in the system. Trichinz 
occur in swine, rats, mice, and cats, and the disease is 


easily reproduced experimentally in rabbits and guinea- 


86 HYGIENIC MEASURES 





pigs. In Northern Germany, where raw ham and sausage 
are much eaten, the disease occurs most frequently. 
Epidemics arising from the use of infected meat supplied 
from a common source have been frequently observed. 
From the fact that calcification of the capsules occurs very 
slowly in the hog the presence of trichinz is overlooked. 
The flesh of hogs may contain an enormous number of 
embryos and the animals appear well nourished and 
healthy. 


Preventive Measures. 


Microscopical examination of samples of different 
muscles (abdominal muscles, diaphragm, intercostal mus- 
cles, muscles of the larynx and tongue) taken from each 
animal slaughtered should be required by law, as is the 
case in Germany. Thorough cooking of the meat contain- 
ing trichinee renders the same harmless. In large joints the 
centre may be insufficiently cooked and the disease be pro- 
duced by the trichine therein. It should be remembered 
that salting and smoking give no assurance of protection. 
According to Heller, the parasite is killed by an exposure 
t0.687; Caer es 2) 

If it has been discovered within twenty-four to thirty- 
six hours that the infected meat has been eaten purgatives 


of rhubarb and senna should be given, or an occasional 


VEOH AON LOL NIACLIOUS DISEASES, 87 








dose of calomel. Diarrhoea in the first days of infection 
is a favorable symptom (Osler, etc.). 


28.— Tuberculosis. 


CAUSE : BACILLUS TUBERCULOSIS.  O. P. 
Mode of Lnfection, etc. 


The infection chiefly spread by the bacilli contained 
in the dried sputa of tuberculous individuals, which 
become pulverized and are inhaled. On account of the 
prevalence of the disease the bacilli are very generally 
distributed in the form of dust which can adhere to 
anything about the patient. Children playing about on 
carpets that have been contaminated with the sputa of 
tuberculous persons may inhale the bacilli in the dust. 
Bacilli have been found in the dust of ill-kept hospital 
wards, and may be scattered about on the street in the 
sputa. As many as four billion bacilli may be expecto- 
rated by a patient in twenty-four hours (Nuttall). Infec- 
tion may occur through milk or meat of tuberculous 
animals. Salted meat may infect, as the bacilli are not 
affected by the process of salting. Direct inoculation 
may occur through sputa on clothes, etc., if they gain 
access to cuts in the hands, etc., in the process of washing. 


Tubercle bacilli can retain their virulence for five months 


88 HYGIENIC MEASURES 





in dried sputum, and in sputum which has undergone 


putrefaction they may remain virulent for forty-three days. 
Preventive Measures. 


Isolation not being practicable, every other means of 
limiting the spread of the disease should be resorted to. 
Impress the patient with the importance of care on his 
part as a duty to others. The sputa, being the chief agent 
in spreading the disease, must be looked to. Kissing 
is to be avoided as a direct means of infection. If the 
sputa be small in quantity the patient can expectorate on 
pieces of toilet paper, which should be burnt promptly. 
The use of handkerchiefs for expectoration is to be con- 
demned, as the sputa readily dry therein, and through 
friction in the pocket the infectious matter is converted 
into dust and scattered about. Sputum cups containing 
five per cent. carbolic solution (dangerous when the 
patient is delirious, as the contents may be swallowed), 
properly closed by a lid to prevent drying, as also the 
entrance of flies, should otherwise be used. The use of 
ordinary spittoons is to be avoided. Healthy persons 
should never be permitted to sleep in the same bed with 
a tuberculous individual. All handkerchiefs, linen 
clothes, etc., contaminated with sputa should be rendered 


sterile before being washed or handled, ‘Tuberculous 


CVPR ELALION LOVIN PLC TIOCUS  DISLA SES, 89 





‘patients should be provided with special eating utensils, 
which should be boiled after using. This should not 
be forgotten in hospitals where tuberculous patients are 
allowed to eat their meals together with others. 
Tuberculous individuals should not be engaged about 
dairies. ‘Tuberculous cattle should be slaughtered, and 
the possible spread of the disease in stables prevented by 
such an arrangement of the stalls that the animals cannot 


come in contact with each other, etc. 
Disinfection. 


Sputum cups and their contents are best disinfected by 
steam sterilization or boiling for half an hour. Boiling 
for five to ten minutes is insufficient to kill all the bacilli. 
Merely scalding the sputum cups is quite ineffectual. Fif- 
teen grammes of sal soda to the litre of water in the steril- 
izer markedly facilitates the cleansing of the cups. When 
dricd sputum is present on objects to be sterilized they 
should be exposed to moist heat at 100° C. for one hour. 
Eating utensils should be treated similarly, as badly washed 
cups, glasses, forks, etc., especially if roughened or jagged, 
might very well spread the disease. If five per cent. 
carbolic acid is used, add it in an equal volume, and mix 
it well with the sputum, letting it stand twenty-four hours. 
\ A shorter period is unsafe. The cup should be disin- 


gO HYGIENIC (MLASUNES, 











fected both on the inside and outside. Strong mineral 
acids are effectual, but disagreeable as well as dangerous 


to handle. Corrosive sublimate is ineffectual. 


29.—Typhoid Fever. 
CAUSE : BACILLUS TYPHI ABDOMINALIS. F., P. 


Mode of Infection, ete. 


The infection is spread through the dejections of the 
patient gaining access to the water supply. From this 
source various foods, vegetables and milk may become 
contaminated, the organisms multiplying readily in the 
latter. The bacilli may remain alive several months in 
the water-supply. They withstand drying for upwards 
of three months, and consequently might float in the air 
as dust. Linen and bedding may remain infectious for 
months. When putrefaction is not too active the bacilli 
withstand the process for three months. They are, more- 
over, relatively resistant to carbolic acid. The bacilli 
are destroyed (Sternberg) by an exposure to moist heat 
at 56° C., (138° F.,) for ten minutes. 


Preventive Measures. 


Where the disease is prevalent, only permit the drinking 
of boiled water or that which has been brought recently 


IVERELALTION FO [NPECTIOUS. DISEASES. QI 





from a source of known purity. Guard against contami- 
nation of any water supply by typhoid dejections. With 
this object, when in the country, where there is no proper 
sewerage, bury the dejections deep and far removed from 
the water supply. Dejections should always be disinfected 
until convalescence is well established. 

The sick-room: No foods, such as milk, bouillon, meat, 
etc., should be left standing in the sick-room, as the 
bacilli multiply readily on gaining access to them. All 
vessels, feeders, cups, jugs, bedpans, etc., that are used 
for the patient, should be marked and kept entirely for 
the use of that patient, and should be cleaned by boiling. 
No discharges from the patient should be left under the 
bed; the bedpans should be promptly removed, and be 
provided with a cover. Mattresses and pillows, when 
liable to become soiled, should be protected with close- 
fitting rubber covers, and, both linen and rubbers be 
immediately removed when soiled. Soiled linen should 
be handled as little as possible, and be placed in a pail at 
the bedside for immediate removal and disinfection as 
early as possible. After the patient has had a discharge 
cleanse the nates with toilet paper, and afterwards with 
compress cloth (moistened with one to four carbolic acid), 
and both are to be burnt. The attendant should disin- 
fect his hands in three per cent. carbolic acid after they 


Q2 HYGIENIC MEASURES 








have been in contact with any object about the patient 


which may have become contaminated. 
Disinfection. 


The discharges of the patient should be disinfected 
promptly—this being best accomplishcd by means of 
milk of lime, directions for the preparation and use of 
which will be found on pages 19 and 40; chloride of lime 
solutions (pages 20 and 41) are also recommended. 

The handling of soiled linen, etc., has been considered 
on the preceding page—directions for the disinfection 


thereof, pages 13 and 38. 


30.—Typhus. 
CAUSE : UNKNOWN. 


Mode of Infection, ete. 


Highly contagious, the infectious matter is retained a 
long time in clothes and bedding. Unsanitary conditions, 
poverty, and crowding of persons promote the develop- 


ment of the disease. 


Preventive Measures. 


Isolation, especially in tents, is recommended, combined 
with complete and prompt disinfection of apartments, 
clothes, etc, 


IN RELATION TO INFECTIOUS DISEASES. 93 


Disinfection. 


See ‘‘ General Directions.” The disease is infectious 


in the first degree. 


31.—Varicella (Chicken-pox). 
CAUSE: UNKNOWN. 


Mode of [nfection, ete. 


A contagious disease of childhood which occurs in 
epidemics or sporadically. (One attack does not afford 
protection against variola.)—(Osler.) Exact knowledge 


regarding the mode of infection is wanting. 
Preventive Measures. 
‘Isolation. 


32.—Yellow Fever. 


CAUSE: UNKNOWN. 
Mode of Lnfection, ete. 


There is no evidence that this disease is acquired 
through contact with the sick to a greater extent than 
cholera or typhoid. It can be carried by fomites. 
There is much that is obscure about yellow fever ; namely, 


94 HYGIENIC MEASURES 





its singular attachments, exhibiting a remarkable indiffer- 
ence to topographical and social conditions. There 1 
no satisfactory evidence that the disease is contracted by 
the use of contaminated water (as in cholera and typhoid), 
whilst there is evidence that the atmospheric air acts as a 
carrier of the infectious agent (Sternberg). The most 
frequent agency in the dissemination of the disease from 
place to place is through yellow-fever patients, but as we 
do not know how they act as carriers, it is best to guard 
ourselves in every direction by a thorough system of dis- 
infection. 

One attack immunifies, as does also long residence in 
places where the disease is endemic—exceptions to this 


rule are rare. 


Preventive Measures. 


According to Sternberg, countries where the disease is 
not endemic should observe the following precautions ; 
(1) exclusion of the exotic germ of the disease by sanitary 
supervision at the port of departure of ships sailing from 
infected ports, and thorough disinfection at the port of 
arrival when there is evidence or reasonable suspicion 
that they are infected ; (2) isolation of the sick on ship- 


board, at quarantine stations, and, so faras practicable, in 


IN RELATION TO INFECTIOUS DISEASES. 95 








recently infected places; (3) disinfection of excreta and 
of the clothing and bedding used by the sick and of 
localities into which the cases have been introduced or 
which have become infected in any way; (4) depopula- 
tion of infected places—that is, the removal of all suscep- 
tible persons whose presence is not necessary for the 
care of the sick. During an epidemic, individuals who 
remain in the locality should avoid the regions in which 
the disease prevails most ; they should live temperately, 
avoiding all excesses, and should be careful not to get 
over-heated, either in the sun or by exercise (Osler). 
Time quarantine of ships and persons on board has been 
shown to be unreliable. The ship may remain infected 
indefinitely, and for this reason should be disinfected as 
soon as practicable. Healthy individuals should be re- 
moved from shipboard or the infected locality to a healthy 
place. Sanitary improvements in cities and vessels sailing 


from infected ports are most effectual (Sternberg). 


Disinfection. 


Excreta and articles soiled therewith should be disin- 
fected—the same system being pursued as in typhoid 
fever (p. 92). Regarding the disinfection of ships see 


page 50. 


96 HYGIENIC MEASURES 





SURGICAL DISINFECTION. } 


(a) Preparation of the Patient for the Operation. 
The patient is bathed the night preceding the day of 


operation, the part is shaved and covered with green soap 
for one to three hours, depending on the degree of sensi- 
tiveness exhibited by the patient. The soap is then 
washed off, if possible the whole body being bathed at 
the time, and the part well scrubbed with a brush to re- 
move the layer of epidermis that has been acted on by 
the soap. This is followed by a moist dressing of corro- 
sive sublimate (1 : 1,000) applied to the part until before 
the operation. In certain cases permanganate of potash 
and oxalic acid are applied as in hand disinfection. 
(Halsted). 


for Gynecological Operations ( Kelly ). 
The patient is bathed daily for usually three days pre- 


ceding operation. ‘The last bath should be taken four to 
six hours before operation. ‘The parts are scrubbed with 
soap and water, shaved, and washed with alcohol and 
ether (the alcohol to dehydrate and the ether to dissolve 
away fats). Finally the part is washed with 1 to 1,000 


! Methods of disinfection employed in the Surgical Departments 
of the Johns Hopkins Hospital, Baltimore. 


IN RELATION TO INFECTIOUS DISEASES. 97 








sublimate and a compress moistened with it placed over 
the part and covered with oiled muslin and a bandage. 
The process of disinfection, at times, including the use of 
permanganate of potash and oxalic acid is repeated before 


the operation. 


(6) Preparation of the Operator and his Assist- 
ants; Garments Worn, Sterilization of 


the Hands » Rubber Gloves. 


The clothes to be worn by the operator and assistants : 
White cotton suits fresh from the laundry, where they have 
been sterilized, should be used. 

Preparation of the hands; The nails should be short 
and smooth. Scrub the hands and forearms well with 
soap and water (not less than 40° C., 194° F.) for five 
minutes ; then place them in warm super-saturated aque- 
ous solution of permanganate of potash, rubbing the skin 
well whilst in the bath, and keeping the parts therein 
until they are stained of a deep mahogany color (one 
minute usually) ; then decolorize completely in a warm, 
super-saturated, aqueous solution of oxalic acid, and 
finally wash off in sterilized salt solution or water. 

Rubber Gloves are best sterilized by boiling five minutes 
in carb. soda solution. They are not injured thereby. 


They should be worn by the assistant who hands the 
7 


98 HYGIENIC MEASURES 





instruments. Finally the hands and forearms can be 
immersed in sublimate solution (1:1,000) for ten minutes. 

(The action of these agents is chiefly one of oxidation, 
This is the only method of hand disinfection which has 


stood the test of recent bacteriological examination.) 


(c) Preparation of Operating Table and Room. 


No dust should be present in the room. All removal 
of dust should be done with a moist cloth or swab moist- 
ened with carbolic acid (five per cent.) or sublimate 
(1 :1,000). No currents of air should be permitted ; 


doors and windows should be kept shut. 


(2) Disinfection of Instruments and Vessels. 


Instruments are best sterilized by being maintained a 
half hour at 100° C. (212° F.) in the Arnold or other 
steam sterilizer. Rusting of instruments is prevented 
by their immediate removal from the sterilizer whilst hot. 

Disinfection of instruments by means of one per cent. 
soda solution (Schimmelbusch)' maintained at boiling 


point for five minutes has also been used, and is applica- 


1 Behring showed that soda lye at 85° C (usually of the concen- 
tration 1.4%) invarably killed anthrax spores within ten minutes and 
oftenin less time. Schimmelbusch showed the pyogenic staphylococci 
and B. pyocyaneus to be killed by an exposure of three seconds to boil- 
ing 1% soda solution, and anthrax spores were killed in two minutes. 


IN RELATION TO INFECTIOUS DISEASES. 99 








ble to all instruments except knives and needles, which 
are sterilized for two minutes at this temperature. The 
soda prevents rusting and increases the sterilizing power. 
The instruments are very slippery when removed from 
the soda solution, and it is well for this reason to rinse 
them in carbolic acid solution (five per cent.), after which 
they are placed in the trays containing carbolic acid 
solution (five per cent.) (Halsted). 

The dishes in which the instruments are placed can 
(1) be filled, for one hour preceding the operation, with 
sublimate (1 to 500), or carbolic acid (five per cent.), 
these solutions being poured out and the dishes hal filled 
with sterilized water, into which the instruments are 
placed ; or (2) dishes and instruments can be washed 
with hot water immediately after an operation, and dis- 
infected before the next operation by being allowed to 
stand one hour filled with 1 to 4o carbolic acid. Vessels 
which contain salt solution should be disinfected with 


corrosive sublimate (1 to 1,000). 


(e) Dressings and Ligatures. 


Bandages, absorbent cotton, moss, and gauze should 
be exposed to a temperature of 100° C. (212° F.) for one 


hour in the steam sterilizer. ‘Towels should be similarly 


100 LIVGIENIC MEASURES 








treated, and can be kept until needed in covered jars 
containing sublimate (1 to 1,000), or carbolic acid (three 
per cent.). Rubber protective should be placed for 
twenty-four hours before using in 1 to 1,000 sublimate. 

Iodoform gauze prepared simply from sterilized gauze. 
As an occlusive dressing the following is used with steril- 
ized gauze cut to proper sizes. k. Washed ether and 
absolute alcohol equal parts ; recrystallized corrosive sub- 
limate q.s. Anthony’s snowy cotton. Add the cotton 
until the consistency of simple syrup is reached. Prepare 
carefully, avoiding as much as possible exposure to the 
air. Place in perfectly dry, wide-mouthed bottles before 
adding cotton. 

Ligatures: Silk, silkworm-gut, and silver are placed 
in test-tube-like glasses plugged with cotton, the first 
being wound on glass spools. They are sterilized for one 
half hour on two consecutive days in the steam steril- 
izer. They can then be indefinitely preserved if kept 
dry to prevent the moulding of the plug. The latter 
can be burnt off before being withdrawn if it has been 
exposed to the dust. 

Catgut should be kept reeled in absolute -alcohol. 
Previous to using it, boil it in the water bath for half 
an hour. Do not use steam or oil as the catgut is 
rendered brittle. 


PVeKeCALION WTO SNFECTIOUS DISEASES. IO01 


(Y) Disinfectant and Sterile Solutions Em- 
ployed and thetr Preparation. 





Carbolic acid, five per cent. ; sublimate, 1 to 1,000; 
for irrigation, normal salt solution (6 to 1,000) sterilized 
by heating over the flame until the boiling-point is 
reached, and then maintained at 100° C. (212° F.) for 
one hour (on three successive days) in the steam steril- 
izer to prevent too great an evaporation during steriliza- 
tion. For washing, sterilized water may be used, being 


prepared in the same way as the normal salt solution. 


Pe , 4 se 
ete k Ube; 





INDEX. 


PAGE 
AGCHIMORIV COStein AY Ne tee tech oars wna etre mes Ns hate orlSa seb hora ve Cancers! ote 54 
PAOLIN ORM VCOSI Sipe ater nisin akin semi ivorneieiste cine mel ciel Teena coud also tiie sheers ear 54 


* BAUSCLOUN AP nINS harvey chelsea dete Vote cece de aelreee Nese s 54 
se MOG S.OLANTECHOM Ni shld seule Sao crete oats wetter oe lok 54 
iT 


preventive measures in........ Sep a onsrarsl a charade fate: Ss stencienciatssets 55 
PN ETALLOM LEC. cietelasie stevie sicisieislelc <6 De ststaptaraccte Breleyel ist oneh ie ouobela: cae’ s/eveheie toy ete\etsiieys 52 
Agents used in disinfection............ saigule Wetiivtle oes S Mya ota ae tasters steriysl v's 3 
GAM OO Lalit COLE CLATEICLES us nis atke ae Arne laPalmialcicl,(eratershalarc love ots ela sroeie! eels eels 25 
Ameceba dysenteriz.................. TASB AE te on, yeh GINO oP Be aN A RR A RR 
PAIN CE DIC AY SENLELY stewie cleietsic sles y ster eisicisisis 1s Nestenteler stu starteic. sie visintete ses tes 61 
PALO INL RRR Mire OTA (ast else ta wie'sta's ofarere'aie!sain de VES Se aed te ds ga eiede'ee ee, 205.85 

SMMC AITSC LOL sammie be coe say et siessFetete a ein oieie es, vier shea ola el slevove wale Ors « ai aleietdietis oa 55 
ISITE OCLC Sm Meee tral he pefarsie hei Nal-tet Lateral ole let tiaihahctelatelale cco ielerele eis slate 57 

PETNOC GLOLINTECHIOMNIT eeyscnisisse tas peaies Datee es oe etter aweled a ceveled valy's © 55 

METOLEVCNLIVeLIMEASUTCS I sire isesv es cia ed ciuisiwesn de hls ele see viaas 56 
PAILISG PLUCK ciara cieitertere has five pis ersiers cle os Seigigv ey wisisrsie eae e's Sich Bioksete 2 
PAC Peni Cl All Grcteretere eh cietistelersversyarc aise tiaiiis aie tis is ieisiais wate tae eis sieis dele dacs ac alegiele s 32 


4c 


Bacilisiant Dra cisenertaataeetamrec cece Se teiis sleet to eiw oly wie pousieialtielelGidialsiel’s Sie dlere cy 


SE CHUTE NOT 12e Gia srattier casts 'alsloipierslafeisisisieys aig Cishelele eidse s SHAD CE SPL cA SEIS Oko: 59 

POET EINITUL GIR Z ON Eatery fy ck ay fs dig ehh c oixis's vis Uarels o's been keh ee ¥seeasines : 66 
SSDS MRP cpmet ete s tee a ep ialefisiale aisietales ale sia ele wipie elaielelee¥'a.e Place’ astve nice 67 
BUMMEMOXUL ANCL pert atic atatapst cle ecersiar cafe viele css cts s viel eieiéie oP 'g wigieciag o/o's'e Qeiaid » hers : 63 
MRO NALS: WIR SA pack le 2G « Gs eiealdis «sls ate clea Pt rie'saisla sv ats eles ¢ sie 69 
oe 


VELA Unyeremeotce ease ic etre ate naiahd ace cel ai'e diel aide ere W's aiethlaivwie'a te eelets 83 

SRLU DET CULOSISE Mont Criran siaacduinte Sana: catsetie ca caleles sieges £38 Rls @nsiers 87 

ARMECVI DELIA D COMMAS Siecle ce Sie ol te recie cP autrsierelsie’ es leis dl didialant vierefS)abelere aateiene go 
IB CALINOMCIOLIES acntevumettaceristcais Heid s'a cleietn ta cle lerale eleie! etbiavs/e lone MES rae ae leitclae 36 

SEMI ECTCCACtIC GSR tae Gaels ea sees ss Sats be helen s saue ds Fouad p4 pe 25 
Bed DAMECISINT CCLIOM OM CONLENES Of seieaicrs cities on cieldie fivieioa'<\cle'so'sin tie ee ciaisists 45 
ES COSLOH Clertateratn trie mete its aispats eaisyavaie att egein aier> clene’ erelstosloislsl si @iers's' "1 « 4 -5)0\ srelle/e/* 44 
Exits AO Up CAUl] Comtotr sscyais elite Gidlciere tlarcietarcists aye) ecote is ccait ole wleve, siete a lieiatare the ois, 54 
Blankets, disinfection ch Pao) Sees TS Ntbise SAE Ma chhietere Lh We Sishere tenes II 
PE SDAMAT COLNE Sey de iar ve tiie hts ce celeas ances oars Een O Ek ERE ER oe 36 


103 


TO4 


INDEX, 





be 6b 


Care of patient's person . san eentaseise rite 


Carelof. sick=roO nan nese ied tue ole aroaiee Gee nuareentate 


eee ewww eene 


Carpets ic .aiccum soamuieb eles as e> 
Carts for transportation......... 


er ea? 


Cause and mode of spreading infectious diseases........ 


Cerebro-spinal meningitis................ 
Cesspools, disinfection of................. 
Chemical disinfection.......... 
Chicken pox.. smetezasles 
Children in infected houses...... 
Chloride of lime..... 
Chloride of lime solution......... 
Choleraw.c. oseus cheats: 


ey 


eee eee eee ee 


seer eee 


Ce 


weet eee 


Cy 


SS IGALISE) Obes cutie coariei e COR Rene 
re MeuchiSINfECtION TdTiaeL cele eee oe oe 
t= mode’ of infection in-s..-2+. see. 
“ee 


preventive Measures iNew. se aes 
Choleraistoolsintoie secs alae ss 
CULES ae 


ee 


Classification of certain diseases according to degree of their infectious- 


TESSa re ee wae ienven : 
Clothes, disinfection of........... 
Commercial disinfectants............... 
Concentrated sulphuric acid...... 


Contagious GiSGaSes: ois cscs v cteisue a eidaeras 


Convalescence...... 


VOD DELASIin Soriozale:stalore aelatertoany -Petatel tere Rape bac : 
COLDSEMys faster cooler ae Rigd haeaad eure 
Gorrosivessublimates.aacssnsarisce ieee 
GLeEwSiOl VeSSelS sa... acdele aeaieetaiercls AP a 


@rudejcarbolic'acid:...c:.nis ashe 
(CCUTLEAINIS BE ainicee aes oaletcoletem teers 


seen 


eeeeee 


Dampyidarkwhouses sui ete « 
DarkneSSiivss eect ouicte wasn 
Deodoranteeseccetne ccna aces 
Diphtheria’ .4i...s%-5<e 

oa CAUSCLOLA LE earrct.alestovers aula crate 
CISiNfeCtiOne Man arceer 


eee eee rw wwe ne 


66 


etere 


ea gb 06 (Ao I LL SC icie Oho Sonor 


ee ey 


CC ee 


eee rere rere seer seseses eee wee wens 
a ee er) eeee 
ee . 
Ce 
enone eee ewer none 


Seem meee e eee ere a ees eee sess seses 
Ce ee a 
Ce ee ed 
seeee 
soe eer ens 


Ce 


CC ee 


er 


Ce ee eee 


ee ey 


ce 


a) 


ee 


aes . 
eC ed 
ee 


ee 


ey ee 
eee ee ee nee ee 
° 
Se ee ween eens Cr ed 
cy wee eee eee 
o- . . oad oe eee eee ee 
. teens ee eres 
. ey . 
. ee a? a a ) oe 
sneer eece eee Cee mew ww we wee . 
eee eee ed eee ewe . 
CD . 
Cd oe 
seee Ce ed 
ee eee od 
ey ee eee eee ee 
eee eee ee . eee eee wee wae seee 
Picton Se ORC Y Ce 


CC cd 


ee 


PAGE 
GALDOLic Acids) ssc\5.:5 ois oisvote ntere chavele ls ofe.eielolele ceanerctare taists Gla ote eierstsyeletece swe erent eae mn Ome 


16 
43 
36 
34 
10 
53 
70 
41 
14 
93 
35 


59 


59 
61 


INDEX. 105 





PAGE 
IDIPULIRETIA wINOGEIOLANTECLION AM aye trevursleits sieiele csc cree ei ce deicie’s v1 wa ce ecacents 59 
. PLevenlives measures ImMaemaace uc ters esiec icine ieee nels 60 

IDI PLOCOCENS PUEUID OMise, <a .gon ce dasicced taaetes args el eee le ade oboe yen yr 
WDISINGECtantrs wea adlee a) ose ele cd SCAG On GEOR Acc aan Topi Peres oldie sierd 
We DEGMICICAlsPOWELLOL negates seen lee Ee ALG crease tasks 15 

PUB BUSIEMPLOY EO n.d cicteit= ii maak SN aie nis rhe cc bade tS LOE 
DISINFE CLAIMS MC OMNMECTCIAL sit, a \sdcie reeves) of siete oc Kier erniord ststaieare tia viele view ars ePerelos 26 
y MY practice; what is desitable:im).: dicge sdey scdoam'y oaheseess 15 
ADISIMPEGLON wagers sac\ele felsles sai etste si ch\e x totah asi (ote sisters tstatteyate Mateo o eeets 2 


ae 


cS AHEM CSMUSE CIT ayaaper ler aeteras abstentions eke latos sts S OCOD AG RAE aOOORE 3 
Ke ys boning vw atersen ce aericr ts «arch ato hnachaboe oo ASE OACGHCOE dope 
. chemical, . =... Byiketa ate} sich s/nss! site vapeaVel Shei ahe AMES iors meld ane tae wtace\G 14 
oy BYRGRVan GA tt rnyes, thats cutere ec. crete else ote sheie's sae aeite ced oo athal arecte mn 
os 


Of EXCLELAZ rte: peer sletesidsviels ole eee e eee cece e eee sere eeceseseee LQy 40 
‘f extent to which it should be carried out................066- 27 
Yat ik Chien eta tra lola lec ctala alton Weies wh clo oh ath elle cision i Pena aes 3 
oy AGES COULTER) VIA MOSSES IG. ha clear cie ial ele oie dpieteeln tw vag sisiels ae 98 
cs Of maiisiandymerchandises...wsecinv cece ce ae phar elatee ora etarshe eves 51 
ie ECE BY CALC Swaine aa alee thin cla as see» SET ioe aean ht Cd CL: 
sf of room after infectious disease.......... 5 iris SGC BICRINIOIE 46 
OPES UPS aetatetote cela che eschete icici side ciel offs ove; joel cisiele's “sluie'sia/sinid.ars 4.4 Seldieiele 50 

sh DygSte allerematanie eietsis oe cersieleraltii nicl sicideisieje/sie sis, sa/e/t ve e'se's seeieh Oe 3 

. Ol awaAter-ClOsetS, CGSSPOOIS, CLC lie i iiintassebecesecvanse 40,41 
PD IGUISECLONS Me SLOM Tort eter tere sia ssie,c aheis waist ha eels aie 4 siete’ oie. 8 o's ldeiuleie's we sie de vee 6 
PSO SAO Le Te CLECuClOLMIN Da ClGr ion aciatecictecis + «ts e.s's «1s wlalsisilg aietsiersletavesoicxs« 38 
RPE rmt eer Cte ALCS tiara fs on iaiv.saie'e a Urinrneio othe Qaralee Adib pie aenla's 8 4 «0 Nierhysl¢ 99 
HDS SSI Se nVVOU TI Cletate gt trreetecin sie tester si ctuicls oietn or ha) oie! @iaie, clove (alas s'otchaisia,'ela.e # aisiare als 45 
PUMSaAS AM MneCOUSIAM ENE e tac neyttlcrete toca qesacle lala Oe tel s\eralers\ ae: «ith alae (ate 31 
eee GTEM TOOT ecole Wis Vo cine ae elereiel cee eek awd <cauiveimwecieteles's 36 
LORURSRINAAY Jo ere ld orld Sogo bn mOUE ans DOO GEC URN  higedoG COCO OHO COUT COC OCU. Hier: 
AT CED LOreeete rer tesla isejelolera Seistsietoisieier ries ale sleiisie 6 sielsrsieleua ole sielsisiereie cise 61 
= ARSON OLN tatarasceteemisls aiesl eholaysiaGe Sele naisie beri h fees sie leis ea bees 61 
fe GUO ON GA Tin oH doohenbbcdc0eo5c bones DUO ONO DE Tan oonononmpK 62 
ss MOdero bela LeCOMMO sire miti lt tiescelsie sess date ene ee sivters seceloreitie 61 
* DLOVEMUVEgMeEASIICES IMs ie foie ericisl feelers iis sisicreicls weYere sty sles ¢isisiels a8 62 


Hating utensils’ disinfection Of... sic. cesses sc desene ene gscctrssccecseese 45 
BreGiRC TT VTOUMGLCT Coates sab cea aes cleleiclsicisie's walncsladwied aps Se ere wieiny aio dr vig 'odinje eg 12 
EAC EMA Ge MALOU Smpatsitstslec e vielaisicieleiels/sisinieic\e aie! isle clereie s/t islelelele cle viviets P aiayeieleiene s 71 
PIO GIAS ects at drive rout ein tee aicie cles ees 5 03a a Fd eid eed eceeaeag ay e's «6 oe 2Qy 02 

8 CAUSEHOLS detache oii inieee co eie eee saserdlelais «ale sfoeld sels ini sielcisnteleis.=1¢ 62 


106 INDEX. 


PAGE 
Erysipelas, disinfectionit iyccunstain’s da {olsen eas tee see eC ya ies ores 63 
ey MOdEeOfUnLECtIG MOM yi lakers era eter etecabarste iste tenets ela ate 62 
PLEVeNtIVe Measines Me cni ee ere eee ete eyes crete ere 62 
Exanthematas a@eute sy. ogarices sere ees wot sistas ate aielle w tategatetinne ls late tots fete fates leemetenenee ae 29 
Excreta,disinfectionsotyarrigcch sees suiieet es seleoit eine semtierat neiey rare ent 19 
Extent to which disinfection should be carried Out..........s.seeeeveees 27 


Ge 


Facultative: parasites swe otceroasten tnnnc tlcteuel ders sonenstte eiete tare ca nissaniene ets leita tetera 53 
Feces. Gisinfectionsodias(sces cic cee Se aero ie eel Sere or eae Dita tia a tect eee tee 40 
FRAT CY sie cae ple 2 oles caaliere ares oiay alc nears Bi lonenewuay=v aaste ocd yaNair cela aie eka ebb etoge ce arm netete oeeteete <a 63 


Sn PAUSE OL. sas cae np vie aisle Re Spee sled mom ee Lie m Sab ernest eal ei = age eee 
#6. -CISINLECLION IN ce eos wah cdot ek Ue ee rea iiire tate careers Ger cee teeter tat 64 
wmode of infectoman se 2).42\cas pes ec atiee tx oie ce erro eaetele Wlaker cul cketatstatar ve terae 63 
eo 


preventive measures In, 7. coc ose os ae sine y cuctane seer tole ia erate atone’ 64 
Fatty substances to the-skin, application of. 1.4)... ¢ss.saseinctie oes oe 30 
Me bris*recurrenss shcien sets sree sisceprag pie bn araera area aig stereos mariana reg glenere tape tecesrttale 75 


a a GAUSELOLT 05 kao prpiate ore wiete epee vlc wsieed toi acai tntsieleret ata eaten ete rater pee 75 
oe is mode of intectiGOnin ace ae ees eae ada. 75 
ce es 


PIeVeNntive MeASULES Ty aes awe sles ais esieeetene tere etait 75 
Floor, of siek=ro Omi s3 iyi cree cae's petamalee Met sale Ray elete once ator aan eeee ater 37 
Food inisick-room yeaa senses sc coe e rats oe ee Hae ae crotae er mecnet eeeierere 36 
FUree@ BELA tion cae ks sired a aaieieird ca lalate cltpwlate Hale aka: Sire Fea ave ate amarar a alrtaale abe atc eaeade ce 52 
Hurnitureofsinfécted Toom.,.: a«dessica inc came inelti leer nies waht ite eer 47 


Gareles of dilute disinfectants s(ciesteitesintciseussieisisiow a eutetorsioenae etetaxene arate 30 
Garments WOP ese <cnail cine ole y + Mile aleuialels aie eee he sie ete tie pgaine eine ae 97 
Germicidal'‘powers ot disinfectant: is. cere ete satelc ssa oie rae teeter 15 
Gla ers sn fois sist sao asi bieles bu oomeie' Ge sin Biota e's ewes ibtele Sra siete canter a acne lmepent one wea roe 


a CAUSE OFF 55. ie uh sisislrnels einer tints sictare eran ie orale pete hase en sot ne ae ea eae 63 
tae CISiNfECtION Le ok evs de Ss eee EN oe sie ee oe eee wins tele en eka 64 
Rs MOS Of INfECtiON IN, fi.5 Vase nema ee Uy meee eee heads aan 63 
oe 


preventive Measures Ins..u ct cscs els seis ierleieta Mice seals etka 64 
Glutinous brow mybreadists i cecsreieiee cies crueyo aia siete neg. ieee oe bebeleins stan eran coors 23 
GOnOrrh Ceans Ssteu ae shi save os wialsiste s b's Geiss ela ale Siaimpretaieaels isle aus Vistelsls sentir area ROS 


Mae CAUSE OL SEaS ie enlace Weare ls ca ou iek ciaelbie wer pante-ureue pt aici nen aUaIN Sets 65 
GiSinfection iN). 6 3 sp GSW crepes are ete elere pls aerate wyae tee eames ean 65 
ai modeofi infection ings. es cea eee awe Oe rere 65 
6b 


preventive ‘Measures Iai sc vaccine as cole aiteypteslie sie Shame tare ee ILO 
Gynzecological operations... Pov. cevseau sss heey vv dew aoe sce ean seals « 96 


FRAN gn BSc teasibeny vives stetet ooh lcdel ashen iets alot nlaTelel stall ater atatel siaisicl stake) set ere aineta ene oes 34 
Hospital: ward) floor Ofy:sisirdtn vr sewer ta elevated gaesdy on Ove aslge Aetmenaiane y 37 


INDEX. 107 





PAGE 
PL VOLO ROCIO Meir waste e ties bs rere dhs ixEp so chive dobar plea cea vseh bbs eGe66 


MY HILO Ce OLN FE CULO MUU rare nticretere ola) iadsleti cial svelel ele Sia.ale eiatSelee.tie « 66 
PEEMEMLIVERIMEASUTES Lis sriclesisa ned sa sisla\e dais pon aterdy.s pie cle-ere« ote 66 
Hygienic measures in relation to infectious diseases..........seeeeeeeees I 


ee 


Ait CCL GM CLOLIIT Olaette are,» vere: aichelstctccialclera atc are aiaiers!#/ a's S.cleis ele sielbicielasleve elaeieree 35 
tre CliO Usa lLbeeaate cits \ cfers als tie craters ciara < «ate a) ate Gprreds sig) ol eldial aleieraysveisie’usiaeince ore 30 
Infectious agents multiplying outside of body.............ccccceecctence 30 
PNT CCHOUS CISCASES Nate ys orecs)e s) suaielais ig) e,eclelers siviere Cte a sisvee« 


as ae 


1D DrVale Gwellingsc rs: sc ccae sense ens Cpaseatiseesecione: a9 
DOME aE Ml eats lay ah ts wage tikes wag wee ty have ewe a biddine cannons eee. 66 


uy CANISCHO Lapa e Tae rete cis eae eee re ete erate ie ara Ret SS els nic taleun alate Sidhe selon et 66 
ne CiSiNfECHOM ING miasuesi nas ects yl t-r edayateh Brel achat al Mertclcte eo atsh Waletel sisters’ 67 
he mode of infection in......... ae Pd BTS Ee seeteries Oe Ns bran tisha ators ste 66 
se 


DUCMCH ELV EMV EAST CSMUNae rot tial aitarerarereicialarslorre Snbeob Anbenedone 67 
MrMabes 0) AM LeCteC DOUSES e012 clays 6 certs scr etrepeind. tyritre 309 NIUE ated. piste ASM WE 
Insects as carriers of infection............. SES TOE CR NCA pas Ev bier siete hie Ze 

BME LEAS CIC=T GOL treet Totateleet ea isicralclo lee! ore se! star sfelaralaters eielaie aialcts s vie/e ia aia e%s 36 


Length of time articles should be exposed to action by steam............ 11 
BCLS Y cease cite trite tial haishos hi cbatcia!s\@ aio] ate'shsdaie sielete JERE R EE Flee See niahiigts Folores 67 
He COSC h Olareaen trtaiecisle airie aye aia syfeleidia oe b siareate oan eve orue we iaishe as clelarsitave syste 67 
CISINLECHLOMMING Mem aelrelion eiclere ciessie.cte ee Beate bscosaecalspetous foley stecshais) #/dyeeln ators 68 
COMM TH OGG OfelTi fe CEOs is ijl cer itets Pieltieie el Vic ieee ls Risley stared Hopeiecate Sirus 67 
SSM OLE VELL Ge MEASHICS Hlewiere s celn/eiaieieieamaielncie 0 tA Aeisieinielca ees © 68 
MS SACRE foe vie eieinleers is sens ois vk haces ovis beh bs icine shells oinainaie vaasee 19 
EOC TW a wes ec eat ais o.oo wefan! ace esi a) a ase inieyaiole, Seore\ay0'9, ose aiepnla ole aieneleiete seal 83 
LOW LEMPETALULC, oo viccevesescvsccescistmecveveevsenssecsesgarsevoneeys 35 


ee 


Mails and merchandise, disinfection Of..........ccssceeccrccccccscesccces 51 
BVM aT iene center etree etere ate aici steisicliotstelsistslatercisisiave sie seic'a lee e/s\sisie aisle Felsyeieie’4 ale ofa sis oie 68 
RRR CAMIGE WO kc shige cde Vins sale ds) a, sivinie he pero pis ee gis Mepistsal avd itdeale ateleurre © 68 
COMTI CTO LMIILECEIOMS Illa ects ceiel-aleieeis clei cts oa Fis \e wie. aicie's)41s aise!) s\syeiels @ 68 
of PTeVeNtive MEASUFES IN... 1... eee eee eee eet e eee e teen eee etes 68 
Malignant C2dema.........e cece ee ccec cece enter ceecsresscesecseesaseeeese 29 69 

: SMPTE OAITGEVOL gol eke oid Surrlaeieie' py eae 9.4 0 s,¥ Wie Bio's w sleie.s Ha. cim ein € 69 

+s MET mode Of NFECLION IN.) .. eager scempnssagss cas esicvesre ces 69 

24 © Preventive MEASUTES IM...... seer ee sees eee reeecneeeres 7° 
Malignant pustule............ cece eee e eee eee e eee nee teen een ene eee eeeeees me 
Mattresses, disinfection Of.........cseee rece eee e cence eter een eeeeeen enone II 
IL CASlES ee Cowes creer nbasse orev noetareraperirrey SPOS MOR ER ERATE ND esepaaass 70 


108 INDEX. 





PAGE 
Measles, pode. of infection in sy. concave stu wwdecisidstemenieats trie swrciea Oa atcele 70 
% preventive measures and disinteetiom Inireans tase sleeraniaats 70 
Measures in which false confidence is frequently placed................. 24 
Mechanical removal of the dust or infectious agent from walls, furniture, 
QL a lese wleelip trier oelehaieleluatel era: siclianexvetet sie teete s toreiavee iol ea epmelpnelstistetsta te hel erate reietsys 22 
Meningitis, ‘cerebroespinallscics {cc <cic/ci ctotelessofole foteloiel stefoelstatoasistatvistcteser iets etetatciere 7° 
= 2 Oh CAUSE: OF iilete ncahs urate ystote mateleetsial siete tops hersys Heel aeprets 7O 
‘iy fa th pOMOGE: Of sINLECtION Ns. cone etoe eee ieclneire 70 
oS i “we PREVENtivG Mm EASUTES IN gecesi sea elastance 71 
Micrococcus so On Orn Ge alrite s sictelriatesiets ciecleiee sine aerate ke ate beter fete at tety 65 
Miles OfT INS hat atein eaiche niet ete letnatarvisteaset cleerclercteteteteteiatete's ator bere teeter eret cetera) 
Moist SUrfaces ois seis ccs sia 2 bon ee orebiels sale inves eoleiar ale cee eel eibeayels Birt 31 
Wi Rel i he eee aa Aan en ar Mrs AAO ae Sree AAR Nai t dio Gadatooge 35 
MOuth ons a sales smi 7 oe ctateiae bee ei ibis Saale er ootsh ors Ge tet Pavers sare ubylatalnca eeeenerelets 45 
MUM psy. cis 0 cia d's ase eliwiarcil ti 0\)0 6 eles Ba loieie ale feete cy aielele e)oraie dtaitegenwiers oh ean Ree Renee 71 
+ smode of infection ines... jciss sot + e\ere vase sisies «eee ce SR RRS 71 
preventive measures 1s :o5\c..0suwam emesis slepiactere te teins tet craters 71 


INALESS oie sig nie cieaie ave cierevs lovee oiatetaiejsuolsia oteteiate’s aire tele eters G lolatoistls Aiee ere) Oiaia tenet: 44 
1 aS aor cmon Oar Dao) [e oT Og oO Murs Saas crtoD.on coUyeaOboio.so0 GAA AS 


INUESE ia cieve ch os eo Patios sivs nis Fe serine chpish seb plage eee ons 6 tee tet unin tets 22 


Obligatory parasite).ola teks is Uinccsp cas pan oo ce ce RR a TaRe ee toner Cee 
Giidema, malignant .57,cic.s ibis ».cisis ese, sieviis sia cre Siieieleisinietefoaiateteteres tone sete lefeleeeteren 2 OOD) 
Ornaments -n.5. se. She eic.bis.aleiseitdpsuteane sire, bon Spa eGrere dieters o1e sioisiere e's eine bieiee pie ae 34 
Oxalicaciduies tase AF Lage Fae do ereod Sid acts hears tka Rta an Lae 2 ae ere 18 
Ozone Jampses is hak sss s vk os cee sagas ence sec ah tee Seep era tunerners sre tereeleteierete res 22 


Paperedi walls e-witiesk teres clestectelaye Cis tee le ate ain atelats ercieatste eyatete ete ia ie aka Sates Eaters 48 
Parasite, facultative: oie is.ba'8 foaiieasas og cote see Riel cuaaie eee ire eee erereietne 53 

rs Obligatory ssjcmeeieui: PA oeidatis chalohacisteler cael ett elie testerte et aratet tetera is 53 
Parotitis sepidemicras.2an cece siicjeneetaruisiels sdayaiey Aah haces teak ai tataveg Saeted, wears 7I 
Permanganate’ of potash i471. cc cch sek as aces! seis secisetenie nine inks eayeeem crane te 18 
Persons engagedsn disinfection of room: sae sarees eee + eel eee ee 46 
PertuSsis. sca. scstelers cate cmlare alelstalsiaslers, orslsteerepslotalatetelsie’s trie sfeltotstaiclalae te siete cre ietereisis 71 

. mode-of; infection InAs iw fis addled ntcomeea non cele eet leptin 71 

Coo e Preventive MeASULES 4s nlc wchuse alee eee arieeiet Rane ks pune Gee ne 72 
Pictures spar wipeteca selduie,Potolaln ctals davies pice Siatem cafe Soke eash ie eres tne In ersten Peers ae 34 
Plasmodium ‘malariaeis sy ja siicteie = eco ciel aiesicle sivte svicie cle deliv ee ne Ooi eral 68 
PNEUMONIA, Be Sacre dl Adise'screus diets fis 3 gare cterthe.els) sisyeletsins a) ele eal seis te ea uieteilete pe Ohne 72 


+ CAUSE Of iiss keds oasis tate seee Fs Colca VON ewe pA ces Tie beh ae siete 72 





INDEX. 


ESNOUIMODIa qCISINECCLIOIII: yalse ata ceca’ cid a ais elon cs bel ewiccia tiene ceueoels date ¢ 


oe 


be 


POtASSIU Ms setae ise sists shes 


mode of infection in... 


Cr a a) 


DLE VEMtVenneaSUresaill ster seisiaec sonics ture slersie ste ohere ett eveaiereteliss 


| 


HLA CCAIEGIECCULONS tere i tefecie ee wo alerts casts Crile aki & tee Cslena ose haede & 
Precautions to be observed by physicians and those in attendance on the 


ed 


Arti ae yATOMIALKS. o rlalttesiafaieitsale tyei-\e'e ois soa elclsvenn she beiaee aes: sy ole 


Preparation of operating table and rooms... 2.5.2.0: .0-6- 00 cee oe + 


ae 


te 


Private dwellings, infectious diseases in.............e. eee e eee 


Public vehicles........... 


ee ay 


CC 


PUEDE AL LOW. Cliwrar. clare) avsiovawiele'e aiareis slale sicielacchalVs/erepelstelers mate aes 


be oe 
ee ae 
se “6 
se oe 


CauselOfsas cence s 


ed 


GISINTECEIOTIA Meas re selsigieis vice ora a ete cla aie she Oita tele oes 
WIOGELOLAMIECLION LN Aactetiieiaters/cvaisrole Nels sive ahele eepe 
PEGVENULVEI CASUECS It ce cfas) cle ter eieleiad'sls ares 2106 


MBS bbe decid oct bodes DOUAE OOOO OE OOOO OSDUCeTibd OnOcomTe bot 


oe 


ce 


oe 


se 


ee ee 


MIOGELOL Wate CLlOMAIMs serdtussie de leis'averels, shaetsye ot esel steie¥s satel aieiels 
DLEVENELVE MEASULES Ulan -lllnstseice es sis ol sia[e'ele'cleleysislerersiel ele 


CAUSETO lee eI ii elects aie ciereciels eideta re Gina aig eys nie etieleis state 
disinfection in.... 


Tay OPC DICIDACLOFIA gn stela citi siereerenelie seisielelsielsisie e's vi-]o\eia)+/eieleje> elaio. es = 


se 


SENG LOC OCCINeer ee etter ote, darlotsterecofe sleveleter es ioln erates 'e eta cha 
AVEOMRCLE Ps CLECLTIC eleierels cleinie/e\s'elele\eiels'¢/s o/s s/nlclo.e enisisicidi elelele vioe/s\« 


RRND TG SORTS Mei err e ere dire afore ete Mic avenue io clelons close el epi sittejelalets sle'aus s dace 


SS METIVOU GC ORiTl ECLIOMPIN persis anayejelcisieicis sie) osie'e sa 6 siareiclecs'soros'e 
s PFeVeNntiVE MEASUTES IN... 5... cece cece ewe esr eer cece sig 


Railway cars, disinfection Of..........s.sseseccsecesecseecneees 
BA Va PUNSUS iacnicines rors am News Heeb es eens cede ecnsemssoteeedes 
BCA DEINE TEV OG. Leese ele eles ss ae viedeu wie saine dees suletisiwanes cae 


Ss Sa CAUSCIOL.... 
“ou “e 
6 ee 


FRO EMELIN eee cateslee etale arn sioee 


sere eer eeeee 


SH mode of infectionin........ 


ReaD el aterecte ccs of cteiare tieteveln ois 


preventive measures in....... 


see eee ee eee 


ee 


ee 


Ce 


re ed 


ce 


es 


Operatoranmdshis| assistantsietaciaccias ected sl lerefelelsleconsieysala cua 'ecs 
MatientelOl Operation. mecca cies se ceils mele oils ee 
Preventive measures in infectious diseaseS...............eeeeeee 


ee a 
es 
oe teens 
oer eeeeene 


eee reeeece 
eee ee eee 
a! 
eee e ne eee . 


MOAGE/Of INFECHON, 11.2 ooo. ce hci ke Soin cee abe veasteeeeceses 
PIEVENtive MEASUTES IM....... cree eeecesesceseccecccrees 


ee ee ee eee 


109 


PAGE 


29, 


73 
72 
73 
7 
27 


31 
27 
98 
97 
96 
33 
33 
42 
as) 
73 
75 
73 
74 
79 
79 
81 


79 
80 
73 


79 
12 


66 
66 
66 
51 
54 
75 
75 
75 


75 
70 


110 INDEX. 





PAGE 
Rubella, modejofinfection jinsswsa we nea deseo tnee ete ott eieiets 76 
ws. Spreventive measures and idisinfeotion in, -nyene ss ses eee ese 76 
Rubber gloves: isis Sg eias Sav eee ee ome Sale eie eee ret meters Char ene 97 
eee dt SHEEES!. sau BAe domipneracian ata aatvvlo nel aFus caaaked caer a tel ste orn eter see 44 


Scanlatinads sciss nares siete stsichis clea cis elsaratis stale sinsiotee eine ees Rin Seles ee aera 76 


ay GISINFECtiON AN. 5 oa Cr cance coke cheeses eae eae at ee ete ae Cee 77 
oe mode-of infection, Ines. vas cue ee ese eich aoe eee ee 76 
4s ; 


preventive:measures In-waaeeres Asean crise eee itaee 77 
pois) 0] Lor 2) bE ee Een Hai eA RAR ce, JME atin Bent 


ye CAUSE OLes soi lacs mieventiam syste attere ties fe.dus tava pecetote elite Alaris tials eae arene 79 
25 disinfection*iniud:..mewdusceeas oot wie POsHAES 5 AUGlole thease eau Met 81 
ut mode.of infection ins), cle >.cne al ste elesaninela cee eet 79 
ee 


PLeVentiVe MEASUTES IMs. see oeiieliys Mu cetera lta L een Te 80 
Ships disinfection ofj) wae. eee eee oe j Sielsorele tere’ Stole aners ee ea eens 50 
SiGk=-roomMm | HOOKS Of ish jos joie te arn/a aushesloie nlesciele e alelcolete ote cick s atone eee aerate a7 
placked limes). cp sien suns os sa) tales Jake aw pe eeis see mee ona i meee ae 19 
Slops, disinfection Of; «cli scans oe es.cens tcean alias nd ee ee eee 37. 
SM AL POX. ai..%. cc eave avaisric oom ates tiaiele Seteloefelacate ences Mis abet teveusts orien Ee eerie 78 


4 AISiNFECHION 1H .n\sois cise inialetaiele ead Home's BUI minie ts gine kl tea aR Rea 79 
re mode of infection inser emieuinivas selene seve cst er eave ee tenes 78 
se 


Preventive Measures in joc piypacies teilserrse me relael ol ederelancr neh cae 78 
Soditim chlorides: io2s «.t).sas cub Gee Rr Ree tit. RPE ete SN Sr 
Spirillum cholerze-A Siaticze.). tetsu clei etree ete erat bras eee 57 
HY sO DETRTCLETL, «<2 osc bie coe bs Cae oe eee ae ee are d yy AM rah ce 75 
Sponges for removal of dust....... Hi aes be ocharstarois acs aie Pues 9 aes SNe Sen ere 23 
SDOTES Siete sieve pina isrornts a o\aints lego treinienstee one teens Brattain ee tee AR yay eae tie 5 
SDTAIY seicaGmicldic Gace Bes sie orb isa a cinvauate (ehepopel sta utente to SOR SISO Be AGE AAS SE Bir hit 22 
Sputa; ‘disinfection rol Asse ovis wie neste ari eeeiere faee restate aie eee ee tener Ag AO 
Staphylocoactyless 8s ia ls bud slo ewete che ate epee SOMERS es on DMR E eae SOUT 
Steam “disinfectors Hoss c adel tee plant cae ae crane Pare emirate att ae 6 
Shits SLEXLHZELS stat’ ale!igie atetiatctataleiolp lelatels wise statecaetantetee sea heise siatatel Hei sere 7 
Sterile solutions employed’... ............5-.+- Fecietaaitare singin iis is SL Oe 
Stértlization ofthe hands. A744.) strc io sietun mesial ele aps anaes sues Rie ane iets 97 
Slervizers Steam po cas dente cease dss MP eae SierAahatoleg ave ara: slosstoletomtore ie otetete 7 
Stools, disinfection, Of F'{sinview sjors tens). wlels aieicheyperievareetem sietiteiele staat ene 19 
SEPEPLOCOCEL GY store J cieididiomniete cin sie e nipke ihleca Sree el ohana neatetete ieteia i eyerate ear etseent tee ei 3 
Streptococcus, ErysSipelatosiacs .ticci . ciacle fe sais eyo tetas teres atte ne ea olen mre tetorae 62 
Sulphate) of arom. .te seieiats siishs @ cia AWp\e Bat SiaTANANE Slave mubie eres axe yoke sae enemy Tee Tae 3 
SUED esis hei Spotl atest’ alata yetetatarlat hs tela d slat ater ecaldl anaveterans: ats Giuaiat as] slaha, ate nice ese eee 20 
Sulphuric Acid... cece cece ese eee eee e ence eee e pete eee eeeeeeeenneenneeeneees 21 


INDEX. Pett 





¥ 


PAGE 
Mee MIDAUEIC BGI CONCEHITALE, ice tcc doe tec eev iver ccStsedotaesctsceg fof om 17 


STEMI YO MUNNONG SCL Cl Clatctetercichct etait ah tie ela! Poo s/ajoieiavictsleie Melee ws elg. « nici aleve ideo acg.clele wie eles 21 
MMMM TO CMKeGCCG ATLIClES. 205+. 12s sao. seWse elds skugieodecesdewere nes 25 
REE PD FOLS ReME Lest lenereteestenmetecerar eft aia’e sleeves ate oieieis sis aseictevers pisyeWiss+ <oeis eels e's are aia wisi deviwia'e's 79 

5 CAUSEEOL is Toss ser ats wed Geena celts 


ve MISIMEECTION IM Masons emacs eric ns eee ENG eles oe oreo ee ne cui 8r 
Us CME EDT SAN CCUON ING 2s: odiacpcaewias Seses Fada casadanee tis vas 79 
ob 


DREMENLLY, GC ROICASUTES IN Sa 4 yaitc ets asale dicta atte oc taaietlal ate valelea’ ts 80 
TEMA TMTC COI 6G srecocs ids cease ss 09,00 vores geese these cedeve See sees) >. 90 
SV DMMIS RTI rele itis cites ivieiale ae aint ce s0disi6'e)s Sho Utbbmer onULOoon coe Bocas 20y OL 
- LISIIFCSCUIONEIN easerstc nro sieptiere tea 6 apielale niecwier eatery BSE en art re eS 83 
3 MOGEOL INECLION [Ne ae aes a eae st eae ata) a Rover ate stace aerate ape cts meedetsen ete 81 
PLSVEMUVE MEASLES 1iasleadenaes tee nes dereists Soest see e ae oy aierere 82 


ce 


BRAT COBD AD ELTy ie arco eetay srtetsrre ton tatererna vats ek's afars lain Wiens diate: dia bie alaiaCeie cieseie pin 6.6 44 
MRR EDULS gre yale ole) orcl civ hind oie Fala bsg 6) eleliys olaie's'e viprale Wisle ae ears = seh 6 8 eisaelae ewan deacl SQ, 03 
os CauSenOfece sce s eee fe os saleid sae Bape ysees ate easiest Dass eslelt nae eie shee 83 


pas CLISIMEE COLON PAIL ante aeieniraratciensr sa aretiare cha cialece lore niga as alsesa; acl sree lelsiwiors are 85 
ok MOU EVOTRTSCLIOM IMs nectric seis eae sitio ais eialarelaleie e'ercis d's; slaves slaicie safe 83 
ab 


preventive measures in............. Renate Natektres crelclctniele omisaieioret ee 84 
PEO WISH CISIIIFE CLLOMINO Lite oct ere ea alofoiets es tetas, ioe araiole Biot eas ete wicls eb. o's simile II 
Transferring patient to hospital, precautions taken in.................66 42 
Pichi WALS DITA iShmcrrectenterscd cir rarciseie se siecle ate! aieleveveters eco ote p sre fterereleyels co 4 c5 Sioiale 85 
BIST ACHAUNIAS (Steele cssrcrevocetstcleyetas reve ate.s erste ahs «ie Aaa Nate eeeteye a pore se GaN detena ses asics 85 

ss CAUSCLOL aria stile jslels a oaioke A ehbhcs ety ae 5 AI OLE ROSA COC 85 
MOE Of MLECHOM Ms ea- te ac ais wteree See OC Bere sgrate le) ats 85 
LEME RUIVERIeA SU Te Sul lionel aiciniercfstieis ci isie eietetclele feels fersia «Ys 86 
SPT OMIOSIG iy sls pao: G clsln ats sehaisigisians sis Wald pes end wr p(e « Sides e a shes he 


oe 


oe 


wb ECANISCROL een eee ee eitakersrs oe naste ans ate ars aie se Sie sae sleselaeers : 87 
CHSUTKEC UOTE LE ators te ete siersecnslae x viel el stare tists ohn tater hai areuoselel a jes: 9ie.0.e, sie 89 
. MIOGE{O fe INLECLIOM ser seepeits 5 aie ane ohefalevavcisisie ate vise c/s ibue einje\es 6 87 
6 


DLE VENLUIV GINeCASUTES Tis .)oe tae dalele aielsieiciaisnielcitie sass ae s/evelere ; 88 
Ay qaluvenvel RS &. on beat ooop GOGO ONO GOO CUDUGHDE doce OUeeLnEtAR ee apeooor 29, 90 
z OO) GRIME) GViane Che tAnnad pad An noc Ode Rondon GoORCpapricodnbem toca go 
sf SEM CISTENLECLION Aina ci ciedie tists sisters als aeicre oie cla tersias Gietttalars’ © ote 6 92 
s TRO CLOSE INTECLION Meret ele eailard gaye cvere eis. slere ajels leis esis f.aels o/s go 
DUC VETILiverMeaSUNES iti cies viele aviciclinimele sr ejsisisiele + oirinic'essteve go 
BIG TONGA "SLOONS ne ctalesetratelels © vieiels Sis alete oes Rati arelstrtces erotics & stolocidice set tae 19 


eo oe 


me CLISITILG CLIOD I Altace trentelstcysisietas ss cse'a'e slole she's meeteie ape, atatat of ee levonsravecetelenstete 93 
SIO CLOT ILE CLIO IT ewnic ter eiaieisieietivieie eas eles oo ole elec 01a (a: cie'sieiaiaseln. e's! ehs\s g2 
66 


PLEVEDUVS MCASUTES TN iis cewek case ceccssueensieverssvesne | Q2 


T12 INDEX. 





‘ PAGE 
Urine} dising ection: ofs.5 as's/ssae ater etsleis eine «citing cslanieitetas cin ek Selate mele eerste 40 


Varicel lay. 2icierts o.0'91044 seas pis rave weietaleven chh-e allen) peters ae te ner Laer Sate Sree arate 93 

‘< mode‘of infection in... cts cones reeetactscirmeitio ncaa one strere ra eiatate 93 

‘E PLEVENEVE! MCASUTES IN sya lertetssteie errata teketeleier stele tere anetear 93 
Vegetative forms of bactetial 3o.0- cn. hits sine male eee Cee aie ees iB 
Vehicles# publics. oi iis sicivcila ss cvsttie cis theisters olars iss rae ote eee ene atest etree een ote 42 
Ventilation of sick-room...............- AE Per omeceh tite’ MECC Orie a She 24 
Vermina sae iisc nas eae SS ¥ go: sap fhila evosegoh avele Ghee a) alge top ee aionehel eee. Memes etc te aceasta 5 


Washes of dilute disinfectants: ....s\).tjecu ones Chand ie aaee ante meee 30 
Weater-closets) ‘disinfection Of... 32. e nee coals tells ee eee eee een ay 
What is desirable in disinfectants in practice............ BP nooks Oosae 15 
Whooping-coug hi. t2.\. vice lites nics oletore aie stole He pote mck oicls NCI che Rear t 

oe i MOE Of INFECKION MH. 1, sale os feslvtalolete eter etaleteneeeetaR Te 71 
PIEVeEDtive Measures IN.y 5 «(emi es nie ve wale) Seis ees 72 
Wrornd dressings siyes 502 kv) ca iislers stan, s thins’ 6's 0s pl alalsls ois es 2 ate ee 43 


se ee 


WV ellOW (fEVer oa ocica sc cistinle ws lotions « cshfoae niet @ ci hina Sect eeiioe Cee eee oEcOMOs 


ai Hier GISINfeCtion Ines 55 cack cceetecekinieeeiie nce tee cer en toate Cerner: 95 
rt “\ smodelof. infection iniwacnce ee ceceee eee Sot te eee cee 93 
oe 6s 


PIEVENLYV.E MEASUTES Ie sls citelel pelt swlelels toile ciatlatoiere eietein a 94 


5 mel 


7 


Ne ee ee Oe ea ye 
Loge bare eich beste 
} i : ay 











B. 


a 


FAN oti OS Ee ERM WE ct 
aes eos 
sn 1 en 734 Se 


a8 .y 


sia beee 


Fe 
©. 


19 "at 
pees 


Fee Dh 


b nS ki 
‘od ty aN ae 
er be nA 
bbe 5 
t 
Master 
Las 


ie Pte 
Ef BH HF 
wk hs st 


hy te : 
eu ae ROR AGS: 
Pita : 
ae eee 
meierge ss 
4 
betas 





per rete 
ib BAT op 
>| 


rhea. 
SAE SDI 


Susana ©: ae 


an ie 


2 3 ; Z 
ae AR it - te OS BT LD PB 
rf 7 + te 


ab, 6. we MA Neat, 
timeslots cole a 
Fey 35 





VERSITY OF ILLINOIS-URBAN 


) 


30112 067732468 





